CAJ | 학술논문

目的观察直接吻合对腰神经根性断裂伤的作用,探讨影响吻合效果的原因.方法成年SD大鼠共20只,随机分为吻合组和不吻合组(每组10只),另设吻合组右侧为吻合侧,左侧为健侧.术后观察各组大鼠的存活情况,对受试鼠进行行为学运动(BBB)评分;比较两组双侧股二头肌、小腿三头肌及胫前肌湿重比和萎缩比;电镜检查吻合口远端神经生长情况;真蓝逆行示踪、肌电图检查以评价吻合的有效性,利用HE染色及TUNNEL法检测吻合术后伤侧脊髓前角运动神经元存活及凋亡情况.结果术后12周吻合组BBB评分[(15.00±1.68)分]均较不吻合组[(8.60±3.27)分]高,差异有统计学意义(t=5.505,P=0.001);两组肌肉湿重比、肌肉萎缩比比较差异均有统计学意义(P＜0.05);吻合组不同肌肉间湿重比和萎缩比比较:胫前肌＜小腿三头肌＜股二头肌,差异均有统计学意义(P＜0.05).荧光纤维镜下可见吻合后新生神经已通过吻合口.吻合组高于不吻合组,吻合组凋亡指数低于不吻合组,差异均有统计学意义(P＜0.05).股二头肌肌电图恢复率优于胫前肌、小腿三头肌,差异有统计学意义(P=0.000).结论腰神经根性断裂伤原位直接吻合能恢复大鼠坐骨神经的部分功能,且能部分保护脊髓前角运动神经元,吻合后神经纤维的丢失及神经生长速度慢于靶肌肉退变速度是影响术后功能恢复的重要原因.
목적 관찰직접문합대요신경근성단렬상적작용,탐토영향문합효과적원인.방법 성년SD대서공20지,수궤분위문합조화불문합조(매조10지),령설문합조우측위문합측,좌측위건측.술후관찰각조대서적존활정황,대수시서진행행위학운동(BBB)평분;비교량조쌍측고이두기、소퇴삼두기급경전기습중비화위축비;전경검사문합구원단신경생장정황;진람역행시종、기전도검사이평개문합적유효성,이용HE염색급TUNNEL법검측문합술후상측척수전각운동신경원존활급조망정황.결과 술후12주문합조BBB평분[(15.00±1.68)분]균교불문합조[(8.60±3.27)분]고,차이유통계학의의(t=5.505,P=0.001);량조기육습중비、기육위축비비교차이균유통계학의의(P＜0.05);문합조불동기육간습중비화위축비비교:경전기＜소퇴삼두기＜고이두기,차이균유통계학의의(P＜0.05).형광섬유경하가견문합후신생신경이통과문합구.문합조고우불문합조,문합조조망지수저우불문합조,차이균유통계학의의(P＜0.05).고이두기기전도회복솔우우경전기、소퇴삼두기,차이유통계학의의(P=0.000).결론 요신경근성단렬상원위직접문합능회복대서좌골신경적부분공능,차능부분보호척수전각운동신경원,문합후신경섬유적주실급신경생장속도만우파기육퇴변속도시영향술후공능회복적중요원인.
Objective To evaluate the effects of in situ anastomosis on the ruptured sciatic nerve root. Methods The animal models of sacral nerve root avulsion were established in 20 adult SD rats in which the fight LA-L6 were avulsed out of the intervertebral foramina.They were randomized into 2 even groups (anastomosis versus non-anastomosis).In group A,we did not reconstruct the ruptured sciatic nerve.In group B,we in situ anastomosed the ruptured nerve roots of L4-L6.The histomorphology of the nerves in each group was observed 12 weeks after operation under microscopy and electron microscopy.The models were evaluated in terms of survival,Basso Beattie Bresnahan (BBB) score,electron microscopic weight and muscle fiber CSA (cross section area) of double biceps femoris,triceps surae and tibial muscle.HE and TUNNEL were used to examine the survival and apoptosis of the motor neurons at the cornu anterius medullae spinalis on the ruptured side after in situ anastomosis. Results At 12 weeks after operation,the BBB score of group B(15.00 ± 1.68) was significantly higher than in group A (8.60 ±3.27) ( t =5.505,P =0.001).A significant difference was observed between the 2 groups in muscle wet weight ratio and muscle fiber CSA ( P ＜0.05).The double biceps femoris had the largest muscle wet weight ratio and muscle fiber CSA,followed by the triceps surae and last by the tibial muscle,with significant differences ( P ＜ 0.05).Newly born nerve crossing the anastomosis was observed.The survival rate of motor neurons in group B was significantly higher than in group A and the apoptosis of motor neurons was significantly lowed than in group B ( P ＜ O.05).The recovery of double biceps femoris was significandy better than that of tibial muscle and triceps surae ( P =0.000).Conclusions In situ anastomosis may be an effective way to repair the sciatic nerve root rupture because it can restore part of the neural function of the sciatic nerve and can preserve part of the motor neurons at the cornu anterius medullae spinalis.Loss of nerve fibers and nerve growth slower than muscle atrophy may impedethe functional recovery achieved by in situ anastomosis.