CAJ | 학술논문

目的观察利用预变性神经移植物行舌下神经-面神经吻合术修复完全性面瘫的治疗效果.方法 30只大鼠分为四组:A组:健康对照组,不做任何处理;B组:离断面神经后不做任何处理;C组:离断面神经后1周即刻修复;D组:离断面神经后9周延迟修复.鼻尖偏离指数实验检测面容对称性;神经电生理检测肌动作电位;半薄及超薄切片观察髓鞘再生;逆行示踪法检测舌下神经的再生.结果鼻尖偏离指数实验检测α角度,修复术后4个月C组比D组α角恢复明显(P＜0.01);肌动作电位检测C组的振幅和峰面积值明显高于D组(P＜0.05).半薄切片显示C组和D组神经移植物内新生髓鞘的数量分别为(1 239±192)个和(559±224)个.超薄切片观察可见C组和D组大鼠神经移植物和与其吻合的面神经中,绝大部分(＞90％)为有髓鞘神经纤维,髓鞘直径为1.0～6.5 μm.逆行示踪显示,在修复术后4个月,C组的舌下神经核中CTB-Alexa555和FG双标记神经元数量明显多于D组(P＜0.05).结论利用预变性神经移植物行舌下神经-面神经吻合术早期治疗完全性面瘫,有助于受神经支配的面肌功能恢复,能够有效地治疗完全性面瘫.
목적 관찰이용예변성신경이식물행설하신경-면신경문합술수복완전성면탄적치료효과.방법 30지대서분위사조:A조:건강대조조,불주임하처리;B조:리단면신경후불주임하처리;C조:리단면신경후1주즉각수복;D조:리단면신경후9주연지수복.비첨편리지수실험검측면용대칭성;신경전생리검측기동작전위;반박급초박절편관찰수초재생;역행시종법검측설하신경적재생.결과 비첨편리지수실험검측α각도,수복술후4개월C조비D조α각회복명현(P＜0.01);기동작전위검측C조적진폭화봉면적치명현고우D조(P＜0.05).반박절편현시C조화D조신경이식물내신생수초적수량분별위(1 239±192)개화(559±224)개.초박절편관찰가견C조화D조대서신경이식물화여기문합적면신경중,절대부분(＞90％)위유수초신경섬유,수초직경위1.0～6.5 μm.역행시종현시,재수복술후4개월,C조적설하신경핵중CTB-Alexa555화FG쌍표기신경원수량명현다우D조(P＜0.05).결론 이용예변성신경이식물행설하신경-면신경문합술조기치료완전성면탄,유조우수신경지배적면기공능회복,능구유효지치료완전성면탄.
Objective To study the hypoglossal-facial nerve anastomosis method combined with predegenerated nerve graft for the treatment of facial palsy in adult rats after facial nerve injury.Methods 30adult male Fisher 344 rats were grouped into A (intact),B (injury),C (reconstruction at 1 week after injury),and D (reconstruction at 9 weeks after injury).The treatment was assessed by the angle α analysis,electrophysiological examination,electron microscopy analysis and retrograde labeling.Results The group D was found a higher recovery of facial symmetry compared to group C (P ＜ 0.01).MAPs displayed significantly greater amplitude and surface values in the group D compared with group C (P ＜ 0.05).Analysis of semithin sections showed numerous regenerating myelinated axons and there were 1 239 ± 192 和 559 ± 224 myelinated axons in group C and group D,respectively.The analysis of ultrathin sections found that the majority (＞90％) of myelinated axons were 1.0 ～6.5 μm in their greatest diameter (including the thickness of their myelin).Among these axons,41％ in group C were larger than 3 μm in their greatest diameter,as compared with only 29％ in group D.There were significantly more double-labeled (CTB-Alexa555 and FG) hypoglossal motoneurons in the rats treated immediately as compared with the number in rats treated after a delay of 9 weeks (P ＜ 0.05).Conclusions The hypoglossal-facial nerve anastomosis method combined with predegenerated nerve graft was effective for the treatment of complete facial palsy in adult rats after facial nerve injury.