自体神经外膜小间隙缝合联合神经碎片及VEGF修复坐骨神经损伤

摘要

目的：：探讨自体神经外膜小间隙缝合联合神经碎片、血管内皮生长因子( vascular endothelial growth factor, VEGF)修复大鼠坐骨神经损伤的可行性及优越性。方法：将SD大鼠随机分为4组,每组10只。对照组大鼠坐骨神经切断后采用传统端端吻合,实验A组采用自体神经外膜小间隙桥接法缝合,实验B组在小间隙内加入神经碎片,实验C组在小间隙再生室加入神经碎片与VEGF。术后12周行神经电生理检测、腓肠肌湿重比检测、HE染色显微镜观察,病理图像分析有髓神经纤维计数、测量再生轴突直径和髓鞘厚度。结果：(1)坐骨神经传导速度比较,实验A组、实验B组、实验C组均高于对照组( P <0.05),实验C组分别高于实验A组和实验B组( P <0.05),实验C组高于实验B组( P <0.05),实验B组高于实验A组( P <0.05)；(2)实验组腓肠肌湿重比优于对照组( P <0.05),实验C组与实验B组均优于实验A组( P <0.05)；(3)组织学观察：各实验组再生神经纤维分布均匀、密集,对照组再生神经纤维较少、排列不规则。与对照组比较,实验A组、实验B组、实验C组有髓神经纤维计数、再生轴突直径、有髓神经纤维髓鞘厚度均升高( P <0.05)；各指标两两比较,实验C组分别高于实验A组和实验B组( P <0.05),实验C组高于实验B组( P <0.05),实验B组高于实验A组( P <0.05)。结论：神经碎片联合VEGF可有效促进损伤神经再生及功能重建。%Objective:To investigate the feasibility and superiority of joint using small gap coaptation autologous epineurium suture, nerve frag-ments and VEGF in repairing damage of rat sciatic nerve. Methods:The SD rats were randomly divided into four groups, 10 rats in each. The sci-atic nerve was transected and directly repaired by end-to-end suture in control group. Pure small gap autologous epineurium coaptation suture was used in experimental group A; The nerve fragments were added to small gap autologous epineurium in experimental group B; The nerve frag-ments and VEGF were added to small gap autologous epineurium in experimental group C;Electroneurophysiological detection, wet-weight ratio of gastrocnemius and HE analysis under optical microscope were performed 12 weeks after operation. to count the number of nerve fiber and check re-generated axons diameter and myelin thickness. Results:1, The conductive speed of sciatic nerve: group C > B > A > control group ( P <0. 05). 2, The wet-weight ratio of gastrocnemius:the gastrocnemius recovery in each experimental group was better than that in control group( P<0. 05) and the gastrocnemius recovery in group B and C were better than that in group A( P <0. 05). 3, The histology and biopsy image analy-sis:all existed regenerating nerve fibers in each experimental group were evenly and densely distributed.;regenerating nerve fibers in control group were less and irregularly arranged. The number of spinal nerve fiber, regenerated axons diameter, myelin thickness in biospy image analysis showed:group C> B> A> control group( P <0. 05). Conclusions:The small gap coaptation autologous epineurium plus nerve fragments and VEGF greatly promotes nerve regeneration and functional recovery after damage.