CAJ | 학술논문

背景:目前,将天然可降解生物材料运用于周围神经外科领域,尤其对于神经损伤程度与生物导管适应证之间的关系的研究报道较少.目的:观察甲壳胺膜管桥接大鼠不同长度坐骨神经缺损,对神经再生的影响.探索此方法在不同程度神经损伤修复中的适应证.设计:完全随机对照实验研究.地点和对象:安徽医科大学实验外科中心.实验对象为清洁级SD大鼠,体质量220～240 g,雌雄不限,由安徽医科大学实验动物中心提供.干预:SD大鼠102只,按缺损长度与神经干直径之比造模分为缺损4,6,8倍组.采用相互对照,用甲壳胺膜管桥接缺损,层流室饲养4,8,12周后处死动物.主要观察指标:术后4,8,12周分别作大体观察、超微结构的透射电镜观察、组织学观察和远端轴突再生率的比较.结果:缺损4,6倍组,能展趾活动,有肌肉收缩现象.缺损8倍组溃疡及肌萎缩加重.桥接体周围无疤痕粘连.缺损4倍组优于缺损6,8倍组,缺损6倍组优于缺损8倍组,缺损4,6倍组髓鞘成熟良好,缺损8倍组仍有髓鞘溃变现象;3组均无胶原纤维增生.结论:甲壳胺膜桥接周围神经缺损,可防止疤痕侵入,有利于轴突再生.对于神经缺损不超过其直径6倍者,用甲壳胺膜管桥接后再生轴突的质量和数量均较优.
배경:목전,장천연가강해생물재료운용우주위신경외과영역,우기대우신경손상정도여생물도관괄응증지간적관계적연구보도교소.목적:관찰갑각알막관교접대서불동장도좌골신경결손,대신경재생적영향.탐색차방법재불동정도신경손상수복중적괄응증.설계:완전수궤대조실험연구.지점화대상:안휘의과대학실험외과중심.실험대상위청길급SD대서,체질량220～240 g,자웅불한,유안휘의과대학실험동물중심제공.간예:SD대서102지,안결손장도여신경간직경지비조모분위결손4,6,8배조.채용상호대조,용갑각알막관교접결손,층류실사양4,8,12주후처사동물.주요관찰지표:술후4,8,12주분별작대체관찰、초미결구적투사전경관찰、조직학관찰화원단축돌재생솔적비교.결과:결손4,6배조,능전지활동,유기육수축현상.결손8배조궤양급기위축가중.교접체주위무파흔점련.결손4배조우우결손6,8배조,결손6배조우우결손8배조,결손4,6배조수초성숙량호,결손8배조잉유수초궤변현상;3조균무효원섬유증생.결론:갑각알막교접주위신경결손,가방지파흔침입,유리우축돌재생.대우신경결손불초과기직경6배자,용갑각알막관교접후재생축돌적질량화수량균교우.
BACKGROUND: Recently, the reports about the application of naturaldegradable biomaterial in peripheral nerve surgery field, especially the rela-tionship between the severity of nerve injury and the indication of biologicalductus, were rare.OBJECTIVE: To observe the impact of bridging the sciatic nerve defect indifferent lengths with chitosan membranous tube on nerve regeneration in therat and to explore the indication of this method in the repair of nerve injurywith different severity.DESIGN: A completely randomized controlled study.SETTING and MATERIALS: The study was completed in the Experi-mental Surgery Center of Anhui Medical University. Subjects were SD rats(grade cleanness) in either gender with a body weight from 220 g to 240 gobtained from Experimental Animal Center of Anhui Medical University.INTERVENTIONS: Totally 102 SD rats were allocated into four-time defect(4-fold defect), six-time defect(6-fold defect) and eight-time defect(8-folddefect) groups according to the ratio of the length of defect to the diameter ofnerve stem. Inter-control was introduced. Defects were bridged by chitosanmembranous tube. Animals were fed in laminar flow room and executed at 4,8 and 12 weeks.MAIN OUTCOME MEASURES: General observations, ultrastructure ob-servations under transmission electron microscope, histology observations andthe comparison in the regeneration rates of axons at distal end were assayedrespectively at 4, 8 and 12 weeks after the surgery.RESULTS: 4-fold and 6-fold defect groups had toe spread-out and musclecontraction. There was no scar adhesion around bridging. The result of4-fold-defect group was better than that of 6-fold defect and 8-fold defectgroups. 6-fold defect group was better than that of 8-fold defect group. Thematurities of myelin sheath in 4-fold and 6-fold defect groups were good, whilethere was still ulceration in myelin sheath in 8-fold defect group. There were nocollagen hyperplasias in all 3 groups.CONCLUSION: Peripheral nerve defect bridged by chitosan membranoustube could prevent the invasion of scar tissue, which is helpful to the regen-eration of axons. The quality and quantity of regenerated axons after thebridging by chitosan membranous tube were preferably good if the length ofnerve defect did not exceed 6 times as its diameter.