不同端-侧缝合方式修复周围神经的比较研究

摘要

目的 比较周围神经标准端-侧缝合方式与其他变体在修复效果上的差异.方法 SD大鼠126只,随机分为7组,将右侧肌皮神经切断,以同侧尺神经作为供体神经,按照端-端缝合组(end-to-end,E-E组)、端-侧缝合组(end-to-side,E-S组)、侧-侧缝合外膜开窗组(side-to-side,S-S组)、侧-侧缝合外膜不开窗组(side-to-side,S-S'组)、螺旋缠绕外膜去除组(spiral,Sp组)、螺旋缠绕外膜保留组(spiral,Sp'组)、阳性对照组(controlling group,CG组)制作模型,各组分别于术后1、2、3个月取材,进行神经电生理、病理组织学检测.结果 术后3个月,各端-侧缝合组均有明显神经再生现象,但效果均不及端-端缝合组,各种端-侧缝合术式的变体与标准端-侧缝合方式相比差异不明显(P＞O.05),保留神经外膜的两组为各组中效果最差.结论 神经外膜对端-侧缝合效果有影响,各种缝合方式差异无统计学意义,单纯通过手术方式提高神经端-侧缝合后神经再生能力的效果非常有限.%Objective To compare the curative effect of standard end-to-side neurorrhaphy and other modifications. Methods A total of 126 SD rats were randomized into 7 groups. The right musculocutaneous nerves were transected in all animals. The ipsilateral ulnar nerve served as the donor nerve. In group 1 the ulnar nerve and musculocutaneous nerve were coaptated in an end-to-end fashion. In group 2, the musculocutaneous nerve was coapted with ulnar nerve in the standard end-to-side fashion. Side-to-side neurorrhaphy with and without an epineural window were undergone in group 3 and 4, respectively. In group 5 and 6, the recipient nerve was coapted with the donor nerve in a helicoid pattern, with and without removal of the epineurium,respectively. The musculocutaneous nerve in group 7 was transected but not reconstructed to serve as control.Electrophysiological and histological analyses were performed in the 1st, 2nd and 3rd month postoperatively.Results By the end of the 3rd month postoperatively, regenerative signs were observed in all end-to-side neurorrhaphy groups. The curative effect of end-to-side coaptation was not as satisfactory as that of end-to-end neurorrhaphy. There was no significant difference among the end-to-side neurorrhaphy groups( P ＞ 0.05). The most unsatisfactory result was observed in groups without removal of the epineural sheath. Conclusion Epineurium had negative impact to nerve regeneration after end-to-side neurorraphy. There was no significant difference among various end-to-side coaptation patterns. Modification of surgical end-to-side neurorrhaphy techniques has limited effect on improving nerve regeneration.