CAJ | 학술논문

目的对治疗周围神经损伤的常规端侧缝合方法进行螺旋式改良端侧缝合实验研究,观察神经再生修复效果,为周围神经损伤的治疗提供效果更好的修复方法.方法选用60只健康SD大鼠,采用右侧腓总神经修复模型.术中根据手术方法的不同,随机分为A、B、C三组,每组20只.每组将右侧腓总神经在其坐骨神经分出后3mm处局部封闭,利刀切断.A组神经远断端切成90°断面,行腓总神经端端缝合；B组神经远断端切成45°斜面,同时供体神经干外束膜开窗行端侧缝合；C组神经远断端切成10°斜面,供体神经干外束膜开窗,以螺旋式改良端侧缝合法进行神经束膜及外膜缝合.术后第8周分别对各组大鼠进行组织学、肌湿重、神经电生理检测,有髓神经纤维计数及神经示踪法观察.结果螺旋式改良缝合组(C组)观察指标均优于常规端侧缝合组(B组)(P＜0.05),与端端缝合组(A组)比较差异无统计学意义(P＞0.05).螺旋式改良端侧缝合法对促进神经纤维的再生明显优于常规端侧缝合法.结论神经断端采用螺旋式改良缝合后,神经再生良好；螺旋式改良缝合法较常规端侧缝合法能获得更有效的神经再生；长入远端的神经纤维多少与受端缝合接触面积大小有关.当临床遇动力神经缺乏时,采用神经螺旋式改良端侧缝合法可获得更好的修复效果.
목적 대치료주위신경손상적상규단측봉합방법진행라선식개량단측봉합실험연구,관찰신경재생수복효과,위주위신경손상적치료제공효과경호적수복방법.방법 선용60지건강SD대서,채용우측비총신경수복모형.술중근거수술방법적불동,수궤분위A、B、C삼조,매조20지.매조장우측비총신경재기좌골신경분출후3mm처국부봉폐,리도절단.A조신경원단단절성90°단면,행비총신경단단봉합；B조신경원단단절성45°사면,동시공체신경간외속막개창행단측봉합；C조신경원단단절성10°사면,공체신경간외속막개창,이라선식개량단측봉합법진행신경속막급외막봉합.술후제8주분별대각조대서진행조직학、기습중、신경전생리검측,유수신경섬유계수급신경시종법관찰.결과 라선식개량봉합조(C조)관찰지표균우우상규단측봉합조(B조)(P＜0.05),여단단봉합조(A조)비교차이무통계학의의(P＞0.05).라선식개량단측봉합법대촉진신경섬유적재생명현우우상규단측봉합법.결론 신경단단채용라선식개량봉합후,신경재생량호；라선식개량봉합법교상규단측봉합법능획득경유효적신경재생；장입원단적신경섬유다소여수단봉합접촉면적대소유관.당림상우동력신경결핍시,채용신경라선식개량단측봉합법가획득경호적수복효과.
Objective To study and compare the effect of normal end-to-side neurorrhaphy and modified spiral end-to-side neurorrhaphy in an animal model,and provide basis for choosing a better nerve repair method in clinical application.Methods Sixty rats were randomized into 3 groups (A,B and C,n =20).In all groups,the right peroneal nerve was transected at the level 3 mm distal to its take-off from the sciatic nerve.In group A,the distal end of the injured peroneal nerve was cut at an angle of 90 degrees,and sutured in an endto-end fashion.In group B,the distal end was transected at an angle of 45 degrees,and sutured in an end-toside neurorrhaphy fashion with an epineurial window in the donor nerve.In group C,the distal end was cut at an angle of 10 degrees,and sutured in a modified spiral end-to-side neurorrhaphy fashion with more epineurial windows in the donor nerve.Histological,electromyographic,muscle wet weight analysis,myelinated nerve counts and neuronal tracing with Dil were performed at the end of 8 weeks postoperatively.Results In group C,the recipient peroneal nerve had regenerated better than that in group B.The difference between group C and group B was significant (P ＜ 0.05),while there was no significant difference between group C and group A (P ＞ 0.05).Conclusion The modified spiral end-to-side neurorrhaphy can enhance axonal sprouting from the donor nerve and improve the functional recovery.The donor nerve epineurial window surface area,the contact configuration and the distal end area of the injured peroneal nerve are the important factors to the end-to-side coaptation model.