CAJ | 학술논문

背景:面神经缺损严重影响患者身心健康及生活质量,临床采用较多的有带蒂颈肌移植术和自体神经移植术等修复面神经缺损,恢复面肌的功能,但上述方法均有其缺点和局限性,使其广泛应用受到限制,寻求一种新的修复面神经缺损的材料是目前研究的热点.目的:探讨自体变性骨骼肌替代神经材料对面神经缺损的修复作用,为进一步提高面神经功能提供理论依据.设计:以动物为研究对象,随机对照的实验研究.单位:一所医学院的解剖学教研室和神经科.材料:实验于2002-04/09在咸宁医学院神经组化研究室进行.选择日本大耳白兔22只,随机分为3组:A组8只以自体变性骨骼肌移植修复,B组8只以自体神经移植修复,C组6只作为正常对照.方法:22只日本大耳白兔左侧面神经上颊支缺损8 mm为模型,术后20周分别对各组实验动物的上颊支神经(含移植体)及其支配的面肌进行电生理学检测及形态学图像观测.主要观察指标:各组电生理检测结果和形态学观察.结果:电生理学检测:在神经干动作电位,面肌复合动作电位,神经传导速度3项对应指标的组间比较,A组和B组比较,差异无显著性意义(P＞0.05),而A,B组与C组比较差异有显著性(P＜0.05).形态学图像分析:神经纤维数:A组(2 559±1 683)条,B组(2 658±1 295)条,C组(3 253±1 564)条;神经纤维直径:A组(4.01±0.88)μm,B组(4.26±0.77)μm,C组(4.98±0.72)μm,再生神经纤维的平均密度:A组(220±30)条/0.013 89 mm2,B组(233±32)条/0.013 89 mm2,C组(315±27)条/0.013 89 mm2,以上3项形态学指标的组间比较,A组与B组间差异均无显著性意义(P＞0.05),而A,B组与C组间差异均有显著性意义(P＜0.05).结论:自体变性骨骼肌可有效引导和促进神经再生并修复面神经缺损,其实验效果与自体神经移植修复效果相当.
배경:면신경결손엄중영향환자신심건강급생활질량,림상채용교다적유대체경기이식술화자체신경이식술등수복면신경결손,회복면기적공능,단상술방법균유기결점화국한성,사기엄범응용수도한제,심구일충신적수복면신경결손적재료시목전연구적열점.목적:탐토자체변성골격기체대신경재료대면신경결손적수복작용,위진일보제고면신경공능제공이론의거.설계:이동물위연구대상,수궤대조적실험연구.단위:일소의학원적해부학교연실화신경과.재료:실험우2002-04/09재함저의학원신경조화연구실진행.선택일본대이백토22지,수궤분위3조:A조8지이자체변성골격기이식수복,B조8지이자체신경이식수복,C조6지작위정상대조.방법:22지일본대이백토좌측면신경상협지결손8 mm위모형,술후20주분별대각조실험동물적상협지신경(함이식체)급기지배적면기진행전생이학검측급형태학도상관측.주요관찰지표:각조전생리검측결과화형태학관찰.결과:전생이학검측:재신경간동작전위,면기복합동작전위,신경전도속도3항대응지표적조간비교,A조화B조비교,차이무현저성의의(P＞0.05),이A,B조여C조비교차이유현저성(P＜0.05).형태학도상분석:신경섬유수:A조(2 559±1 683)조,B조(2 658±1 295)조,C조(3 253±1 564)조;신경섬유직경:A조(4.01±0.88)μm,B조(4.26±0.77)μm,C조(4.98±0.72)μm,재생신경섬유적평균밀도:A조(220±30)조/0.013 89 mm2,B조(233±32)조/0.013 89 mm2,C조(315±27)조/0.013 89 mm2,이상3항형태학지표적조간비교,A조여B조간차이균무현저성의의(P＞0.05),이A,B조여C조간차이균유현저성의의(P＜0.05).결론:자체변성골격기가유효인도화촉진신경재생병수복면신경결손,기실험효과여자체신경이식수복효과상당.
BACKGROUND: Facial nerve defect seriously impacts the mental and physical health of patients as well as their quality of life. Pediceled neck muscle transplant and autologous nerve transplant have been used in clinical to repair facial nerve defect and restore the facial muscle function. However,there are disadvantages and limits of above methods which have restricted their wide application of them. It is a research hotspot for looking for a new material to repair facial nerve defect.OBJECTIVE: To investigate the effects of autologous degenerative skeletal muscle to repair facial nerve defect and provide theoretic basis for further improving the functions of facial nerve.DESIGN: Randomized controlled study based on animals.SETTING: Anatomy department and neurological department in a medical college.MATERIALS: The experiment was completed in the Neuro-histochemical Teaching Section of Xianning Medical College from April to September 2002. Twenty-two Japanese big ear rabbits were randomly divided into 3 groups: 8 in group A to conduct autologous degenerative skeletal muscle transplant, 8 in group B to conduct autologous nerve transplant and 6 in group C as normal control.METHODS: Animal model was built by make 8 mm defect of zygomatic branch of left facial nerve in 22 rabbits. Electrophysiological examination and morphologic observation were conducted to the zygomatic branch of facial nerve and the muscle it controlled to rabbits after 20 weeks.MAIN OUTCOME MEASURES: Electrophysiological examination results and morphologic observation of each group.RESULTS: Electrophysiological examination: Neural stem action potential (NAP), compound facial muscles action potential(cMAP) and nerve conduction velocity(NCV) were compared between groups. There was no difference between group A and B( P ＞ 0.05) while significant difference existed between group A and C, B and C ( P ＜ 0.05) . Morphological image analysis:number of nerve fibers was 2 559 ± 1 683 in group A, 2 658 ± 1 295 in group B and 3 253 ± 1 564 in group C. Diameter of nerve fiber was(4. 01 ± 0. 88) μm,(4. 26 ±0.77) μm, (4.98 ± 0. 72) μm for the three groups, respectively.Average density of regenerated nerve fiber: was(220 ±30) /0. 013 89 mm2,(233 ±32) /0. 0138 9 mm2, (315 ±27)/0. 013 89 mm2, respectively. When comparing the above parameters between groups, there was no difference between group A and B( P ＞ 0. 05), while there was significant difference between group A and C, B and C ( P ＜ 0.05).CONCLUSION: Autologous degenerative skeletal muscle can effectively induce and stimulate the regeneration of nerve and repair the facial nerve defect with the equivalent effects of autologous nerve transplant.