【作者】 张培训； 姜保国； 赵富强； 傅中国； 张殿英； 杜婵； 张宏波；

【Author】 Zhang peixun Jiang baoguo Zhao fuqiang Fu zhongguo Zhang dianying Du chan Zhang hongbo Department of trauma and orthopedics,People’s hospital,Peking University,Beijing 100044 China.

【机构】 北京大学人民医院；

【摘要】 目的探讨一种脱乙酰甲{壳质生物套管小间隙桥接周围神经损伤的可行性。方法将SD 大鼠右侧坐骨神经切断,按手术方法随机分为5组,A组:神经外膜原位缝合(n=24),B 组:套管小间隙原位桥接(n=24,间隙5mm),C组:两断端相对旋转180度后外膜缝合(n=24),D组:两断端相对旋转180度后套管小间隙桥接(n=24,间隙5mm),E组:套管小间隙原位桥接(n=24,间隙5mm)后间隙内注射神经生长因子(NGF)。术后2、4、6、8周分别进行电生理学检查、组织学检查以及计算单位视野有髓神经纤维数。结果组织学检查术后4周各实验组的神经远端均见到再生的神经纤维;小间隙套管组(B,D 组)运动神经传导速度在各个时间检测点上均好于相应的直接外膜缝合组(A 组)和旋转后直接外膜缝合组(C 组)(p<0.05)。小间隙套管组(B,D 组)神经远端的有髓神经纤维计数在4、6、8周三个检测点上高于相应的直接外膜缝合组(A 组)和旋转后直接外膜缝合组(C 组)(p<0.01);在2周时差异没有显著意义(p>0.05)。注射NGF 组的各项指标与小间隙桥接各组无显著性差异(p>0.05)。结论甲壳质生物套管小间隙(5mm)桥接的修复周围的效果好于断端外膜直接缝合,具有替代直接神经外膜缝合的临床应用可行性。更多还原

【Abstract】 Objective To investigate the possibility of bridging smallperipheral nerve gap using a de-acetyl chitosan conduit.Method The sciaticnerves of rihgt sides were cut at SD rats.They were divided into 5 groupsrandomly:group A:epineurium suture in situ(n=24);group B:Biologicalconduit with a small gap for bridging the peripheral nerve(n=24,with 5mmgap);group C:epineurium suture with distal stump rotated 180°(n=24);groupD:bridging the nerve by biological conduits with a small gap,but the distal stump rotated 180°(n=24,with 5mm gap);group E:Biological conduit with asmall gap for bridging the peripheral nerve with NGF(n=24).Electrophysiological examination、histological examination and myelinatedaxon counting were applied after 2、4、6、8 weeks after operation respectively.Result Regenerated nerve fibers were seen in the distal nerve segments of allfive groups;The nerve conduction velocity of small gap group(group B,D)were faster than that of corresponding simple epineurium suture group(groupA,C)at all 2、4、6、8 week time point(p<0.05).The myelinated axon countingof small gap group(group B,D)were faster than that of corresponding simpleepineurium suture group(group A,C)at all 4、6、8 week time point(p<0.01),andthere was no statistically significant difference at 2 week time point.Therewere no statistically significant difference among group E(NGFgroup)andcorresponding conduit bridging group(group B,D)(p>0.05).Conclusion Therepair effects of chitin conduit bridging peripheral nerve with small gap(5mm)were better than that of epineurium suture directly,and possessed thepotential to substitute the epineurium suture.更多还原