【摘要】 目的:从神经血供和溃变两方面对自体神经的移植效果进行分析,观察神经游离移植后的电生理及组织学变化。方法:实验于2001-01/2002-06在白求恩国际和平医院动物实验室完成。①实验分组及方法:选用Wistar大鼠120只,按随机数字表法分为7组,正常对照组12只;其余108只根据移植神经的溃变时间分为3组,分别为健康(未溃变)、溃变1,4周组,每组再根据是否存在尺神经血供分为带和不带血供神经移植组。以双上肢为观察对象,以尺神经桥接正中神经缺损。②实验评估:各组分别于术后第4,8,12周在移植尺神经的中段和正中神经远端距吻合口3mm处,分别取材进行显微解剖观察和光镜观察,测量移植尺神经及正中神经远端横截面轴突的数目,并计算出有髓神经轴突的再生率;于术后第12周测定神经传导速度、诱发电位波幅及潜伏期;术后第12周切取正中神经行电镜观察。结果:120只大鼠全部进入结果分析。①神经外观各组间无明显差异,健康神经移植组移植术后神经与周围组织间粘连最轻。②移植术后第8,12周,相同溃变时间带血供组的神经轴突再生率高于不带血供组(P<0.05);健康神经组高于溃变神经组(P<0.05)。健康神经组与溃变1周组神经纤维生长情况差异无显著性意义(P>0.05)。③移植术后12周,相同溃变时间带血供组的尺神经及正中神经传导速度、诱发电位波幅均高于不带血供组(P<0.05),潜伏期短于不带血供组(P<0.05),而带血供组组间以及不带血供组差异均无显著性意义(P>0.05)。④带血供溃变1周神经轴突生长最好。结论:带血供溃变神经移植优于不带血供的溃变神经,带血供的短期溃变神经可以用来代替健康神经移植。更多还原

【Abstract】 AIM: To investigate the effect of nerve regeneration of vascularized nerve graft through blood supply and degeneration intervals, and observe the electrophysiological and histological changes after nerve graft. METHODS: The experiment was performed in the animal laboratory of Bethune International Peace Hospital from January 2001 to June 2002. ①120 Wistar rats were randomized into 7 groups: normal control group (n =12), and healthy group (no degeneration), degeneration for 1, and 4 weeks groups. The latter 3 groups were subdivided into two groups according to the blood supply of grafting ulnar nerve. The both upper extremities served as subjects, and the median nerve was bridged with ulnar nerve. ②The intermediate segment of grafting ulnar nerve and distal segment of median nerve 3 mm from stoma were harvested at 4, 8 and 12 weeks after nerve grafting for microdissection and microscopic observation. The number of axon at the transverse section of median nerve and ulnar nerve was calculated, and the regeneration rate of myelinated axon was counted. Nerve conduction velocity, the amplitude and latency of evoked potential were measured at the postoperative week 12. The median nerve was taken for microscopic examination at the 12th week postoperatively. RESULTS: All 120 rats were involved in the result analysis. ①There was no distinct difference in the appearance of nerve in each group; the adhesion to surrounding tissue and neuroma in fresh nerve grafting was not obvious. ②At the 8th and 12th weeks after grafting, vascularized nerve graft was better than non-vascularized nerve graft in the neural axon regeneration rate (P < 0.05), and the fresh nerve group was better than degeneration group (P < 0.05). There was no obvious in the growth condition of nerve fiber in fresh nerve group and one-week groups (P > 0.05). ③At postoperative week 12, the nerve conduction velocity, and the amplitude of evoked potential in vascularized ulnar nerve and median nerve were higher but latency was shorter than those in non-vascularized nerve groups at the same time point (P < 0.05). No difference was found between vascularized nerve groups or non-vascularized groups (P > 0.05). ④The neural axon regeneration condition was the best in vascularized one-week nerve group. CONCLUSION: Vascularized nerve graft is superior to non-vascularized nerve graft. Vascularized nerve with short-time degeneration can replace fresh nerve to repair peripheral nerve defect.更多还原