曲安奈德局部应用对周围神经再生影响的实验研究

【作者】 张磊；

【导师】 王海波；

【作者基本信息】 青岛大学 ， 普外科， 2011， 硕士

【摘要】 目的：观察曲安奈德局部应用在新西兰兔周围神经损伤后神经再生中的作用。方法：36只6月龄新西兰大白兔随机分为3组,A组为曲安奈德组,B组为甲基泼尼松龙组,C组为生理盐水对照组,每组再按取材时间不同分为2、4、8、16周四个亚组各3只。将新西兰兔双侧胫神经切断后行端端缝合,吻合口周围A组用曲安奈德注射液局部注射,B组用甲基泼尼松龙注射液局部注射,C组用生理盐水局部注射。于术后2、4、8、16周肉眼观察兔步态、足底溃疡及愈合情况、神经吻合口周围粘连程度；HE染色光镜观察再生神经通过吻合口情况及吻合口周围结缔组织增生情况。于术后16周检测胫神经神经传导速度、诱发电位波幅及潜伏期；显微镜下计数吻合口远端及近端的有髓神经纤维数目并计算有髓神经纤维再生率,完整取下双侧小腿三头肌称湿重。结果：曲安奈德组和甲基泼尼松龙组步态、足底溃疡及愈合情况均优于生理盐水对照组,且均较少出现神经吻合口周围粘连,镜下观察吻合口周围再生神经纤维较多,结缔组织增生较少；在神经传导速度、有髓神经纤维再生率、小腿三头肌湿重比等方面明显优于对照组(P<0.01)。曲安奈德组和甲基泼尼松龙组在上述各指标中无明显差异(P>0.05)。结论：周围神经损伤修复术中局部应用曲安奈德处理神经吻合口,能有效防止周围神经粘连,促进周围神经再生。更多还原

【Abstract】 Objective:To investigate the effect of local application of triamcinolone acetonide on peripheral nerve regeneration after peripheral nerve injury in New Zealand rabbits.Methods:Six-month-old New Zealand white rabbits (n=36) were randomly divided into 3 groups:triamcinolone acetonide group (group A), methylprednisolone group (group B) and normal saline control group (group C), likewise, according to the time of the specimen taking at 2,4,8 and 16 weeks after operation, each group was randomly subdivided into four subgroups (n=3). The tibial nerves on both sides of New Zealand rabbits were cut and sutured by end-to-end way. The sutured areas were treated with local injection of triamcinolone acetonide as group A, methylprednisolone as group B and 0.9% NaCl as group C. At 2,4,8,16 weeks after surgery, the gait, plantar ulcer healing and nerve adhesion degree were observed by naked eyes; the regenerative nerve fiber through the anastomosed site and connective tissue hyperplasia were observed by light microscope with HE staining. At postoperative 16 weeks, nerve conduction velocity (NCV), evoked potential amplitude and latent period were detected; myelinated nerve fibers in the proximal end and distal end of anastomosis were counted by light microscope and the regeneration rate of myelinated nerve fibers were calculated; humid weight of bilateral triceps muscle of the calves were measured.Results: In the triamcinolone acetonide group and methylprednisolone group, the gait ability and plantar ulcer healing status were all significantly better than those in control group, also were less likely to present in extraneurial adhesion formation;in histological examination, more regenerative nerve fiber and less connective tissue hyperplasia were observed around the anastomosed site. The nerve conduction velocity, the regeneration ratio of myelinated nerve fiber and the wet mass of triceps surae muscle in experimental groups were obviously better than those in control group (P<0.01).But there was no significant difference between group A and group B in above parameters(P>0.05). Conclusion:Local applying of triamcinolone acetonide to the anastomosed site in the repair surgery of peripheral nerve injuries can effectively prevent adhesion and promote regeneration of peripheral nerve.更多还原