CAJ | 학술논문

目的比较不同供体神经端-侧缝合修复臂丛神经损伤效果的差异.方法 SD大鼠90只,随机分为5组,切断右侧颈5、6神经根,模拟臂丛上干损伤,分别以膈神经及同侧颈7神经根作为供体神经,按照端-端和端-侧两种缝合方式修复患侧肌皮神经,另一组作为对照组,不予修复.各组分别于术后1、2、3个月取材,作神经行为学评分、电生理及病理组织学检测.结果术后3个月,以不同供体神经行端-侧缝合组均有明显神经再生现象,但效果不及对应的端-端缝合组(P＜0.05).同侧颈7神经根端-侧缝合组,其行为学评分、肱二头肌复合肌肉动作电位、肌肉和神经组织学检测为各修复组最低,差异有统计学意义(P＜0.05).结论在大鼠上干损伤模型中,采用不同的供体神经进行端-侧缝合效果存在差异,膈神经与同侧颈7神经相比,是端-侧缝合相对较好的供体神经;利用神经端-侧缝合修复臂丛神经损伤的效果尚不能达到与端-端缝合相同的效果,临床使用需掌握严格的适应证.
목적 비교불동공체신경단-측봉합수복비총신경손상효과적차이.방법 SD대서90지,수궤분위5조,절단우측경5、6신경근,모의비총상간손상,분별이격신경급동측경7신경근작위공체신경,안조단-단화단-측량충봉합방식수복환측기피신경,령일조작위대조조,불여수복.각조분별우술후1、2、3개월취재,작신경행위학평분、전생리급병리조직학검측.결과 술후3개월,이불동공체신경행단-측봉합조균유명현신경재생현상,단효과불급대응적단-단봉합조(P＜0.05).동측경7신경근단-측봉합조,기행위학평분、굉이두기복합기육동작전위、기육화신경조직학검측위각수복조최저,차이유통계학의의(P＜0.05).결론 재대서상간손상모형중,채용불동적공체신경진행단-측봉합효과존재차이,격신경여동측경7신경상비,시단-측봉합상대교호적공체신경;이용신경단-측봉합수복비총신경손상적효과상불능체도여단-단봉합상동적효과,림상사용수장악엄격적괄응증.
Objective To evaluate the effectiveness of end-to-side coaptation using different donor nerves in nerve reconstruction of brachial plexus injuries. Methods Ninety SD rats were subjected to brachial plexus upper trunk injury and randomized into 5 goups.The right musculocutaneous nerves of 4 groups were reonstructed by both end-to-side and end-to-end neurorraphy using phrenic nerve and ipsilateral C7 root respectively.Another group served as control without any nerve reconstruction.Electrophysiologic and histologic examinations,accompanied with behavioral tests were performed in the 1st,2nd and 3rd month postoperatively.Results By the end of the experiment at 3rd month postoperatively,regenerative signs indicated that reinnervation was possible by end-to-side neurotization.However its outcomes were significantly inferior to these of the end-to-end neurorrhaphy (P ＜ 0.05).The use of the ipsilateral C7 root as a donor nerve in the end-to-side neurorrhaphy resulted in least regeneration judging by behavioral tests,compound muscle action potential and neuromorphometry(P＜0.05). Conclusion It is possible to reconstruct the musculocutaneous nerves in rats of brachial plexus injury by end-to-side neurorraphy.The efficacy of various donor nerves is distinct.The phrenic nerve served as a better motor nerve in end-to-side coaptation,comparing with the ipsilateral C7 root.End-to-side neurorrhaphy cannot achieve the same results as end-to-end neurorraphy,and therefore should be used with caution as an alternative for brachial plexus reconstruction.