CAJ | 학술논문

目的通过设计并建立周围神经结扎的大鼠实验模型,初步探求各种手术方法(神经松解、缝合或移植)对于结扎后周围神经病变的治疗效果.方法取144只大鼠随机分为三组:神经松解组、神经缝合组及神经移植组.先进行坐骨神经结扎,建立实验模型,2周后分别进行松解、缝合或移植处理,并于第二次术后1、2、4、6、8、10、12周处死大鼠,分别测定腓肠肌即时湿重及神经纤维计数,并进行统计学分析.结果单纯缝扎神经,未做其他进一步处理的对照侧,在术后12周,腓肠肌湿重有明显恢复；而双环结扎,多部位结扎病变的对照侧,至实验结束的12周,肌肉湿重及神经纤维再生数量增加均不明显；神经松解组大鼠,自神经松解后4周及6周,肌肉湿重与神经纤维再生数量均有明显改善,差异有统计学意义；神经缝合组大鼠,自第6周开始,肌肉湿重增加,差异有统计学意义,而神经纤维再生计数,实验组与对照组相比,差异无统计学意义；神经移植组大鼠,术后第6周开始,肌肉湿重增加,差异有统计学意义,术后第12周,肌肉湿重对比,差异无统计学意义,而神经纤维再生计数在术后第12周,差异有统计学意义.结论对于周围神经结扎后神经狭窄病例,保守治疗至症状出现后12周,如仍无明显改善,应积极考虑手术干预.神经松解的有效性优于对照侧的非手术干预处理.神经切除后再缝合的有效性尚不清晰,选择仍应慎重.对于长段的多部位的神经狭窄病变,神经移植可作为满意的治疗手段.
목적 통과설계병건립주위신경결찰적대서실험모형,초보탐구각충수술방법(신경송해、봉합혹이식)대우결찰후주위신경병변적치료효과.방법 취144지대서수궤분위삼조:신경송해조、신경봉합조급신경이식조.선진행좌골신경결찰,건립실험모형,2주후분별진행송해、봉합혹이식처리,병우제이차술후1、2、4、6、8、10、12주처사대서,분별측정비장기즉시습중급신경섬유계수,병진행통계학분석.결과 단순봉찰신경,미주기타진일보처리적대조측,재술후12주,비장기습중유명현회복；이쌍배결찰,다부위결찰병변적대조측,지실험결속적12주,기육습중급신경섬유재생수량증가균불명현；신경송해조대서,자신경송해후4주급6주,기육습중여신경섬유재생수량균유명현개선,차이유통계학의의；신경봉합조대서,자제6주개시,기육습중증가,차이유통계학의의,이신경섬유재생계수,실험조여대조조상비,차이무통계학의의；신경이식조대서,술후제6주개시,기육습중증가,차이유통계학의의,술후제12주,기육습중대비,차이무통계학의의,이신경섬유재생계수재술후제12주,차이유통계학의의.결론 대우주위신경결찰후신경협착병례,보수치료지증상출현후12주,여잉무명현개선,응적겁고필수술간예.신경송해적유효성우우대조측적비수술간예처리.신경절제후재봉합적유효성상불청석,선택잉응신중.대우장단적다부위적신경협착병변,신경이식가작위만의적치료수단.
Objective To study the results of several operative methods (neurolysis,nerve repair and nerve grafting) for the treatment of the ligated peripheral nerves using rat models.Methods A total of 144 rats were randomly assigned to 3 groups:neurolysis group,nerve repair group and nerve grafting group.Ligation of the sciatic nerve was done first in all the animals to establish the nerve injury model.After 2 weeks,a second surgery was carried out to treat the nerve lesion.Neurolysis,nerve repair or nerve grafting was carried out according to group assignment.The rats were sacrificed at postoperative week 1,2,4,6,8,10 and 12 respectively.Weight of the gastrocnemius muscle was measured and the myelinated nerve ftber cotmt of the sciatic nerve was evaluated.Results were analyzed statisticafly to make comparison among the groups.Results Gastrocnemius muscle weight recovered after 12 weeks of single ligation of the sciatic nerve in the control group in which no treatment was carried out.Muscle weight and myelinated nerve fiber count,however,did not show obvious increase in the double ligation group where multiple lesion of the sciatic nerve was created but not treated.In the neurolysis group,4 and 6 weeks after the second procedure,gastrocnemius muscle weight and myelinated fiber count of the sciatic nerve of the experimental side were significantly higher than those of the contralateral side.In the nerve repair group,at 6 weeks after the procedure,gastrocnemius muscle weight of the experimental side was significantly higher than that of the contralateral side,whereas the sciatic nerve myelinated fiber count was not significantly different.In the nerve grafting group,gastrocnemius muscle veight of the experimental side was significantly higher than that of the contralateral side at 6 weeks after the procedure,while the sciatic nerve myelinated fiber count was signfificantly better at 12 weeks.Conclusion For ligation induced stenosis of the peripheral nerve,surgical intervention should be considered proactively if there is no improvement after 12 weeks of conservative treatment.Neurolysis would lead to better results than conservative treatment and is the recommended procedure.The results of nerve repair are not certain.Thus this procedure should be chosen with caution.For multiple or wide range stenosis of the nerve,resection of the lesion area and nerve grafting should be the treatment of choice.