CAJ | 학술논문

目的观察股薄肌移植在臂丛损伤治疗中显微组织学变化及神经纤维数量变化.方法新鲜尸体下肢标本6具(成年男性),显微镜下分离观察股薄肌肌支神经,标记方位后在不同平面取材,4％甲醛溶液固定后冰冻切片,行改良Kamovsky-Roots法AchE组织化学染色,观察神经组织染色结果及不同断面上的神经束分布情况;石蜡包埋切片,行Loyez髓鞘染色法染色,应用图像分析系统对组织切片进行定量分析:测算各神经断面有髓神经纤维数目、神经束截面积和神经干截面积,计算神经束和结缔组织所占比例并采用配对样本t检验.结果低倍镜下股薄肌肌支神经束大多数神经纤维呈现酶活性反应,有少量稀疏的块状酶染区.高倍镜下神经纤维形态清晰可见,轴突染色,髓鞘及周围结缔组织不染色.应用Loyez髓鞘染色法显示断面有髓神经纤维,通过图像分析系统,能够测算神经分支及各断面的神经纤维数目和结缔组织面积等指标.股薄肌神经有髓神经纤维数为(1958±375)根.前、后支有髓神经纤维数,前、后支截面积差异均有统计学意义,P＜ 0.05,后支的神经纤维数和截面积大于前支.股薄肌神经干上各个平面之间结缔组织面积差异均有统计学意义(P＜0.05),结缔组织所占比例向远端逐渐增加,而神经束所占比例的变化趋势和结缔组织相反.结论应用AchE组织化学染色方法,股薄肌神经运动束的特征清晰可辨,结合显微解剖结果,能够明确股薄肌神经束的走行及分布情况.应用Loyez髓鞘染色法通过定量分析可明确神经纤维数,有助于选择合适的供体神经,保证两吻合神经之间达到相互匹配.
목적 관찰고박기이식재비총손상치료중현미조직학변화급신경섬유수량변화.방법 신선시체하지표본6구(성년남성),현미경하분리관찰고박기기지신경,표기방위후재불동평면취재,4％갑철용액고정후빙동절편,행개량Kamovsky-Roots법AchE조직화학염색,관찰신경조직염색결과급불동단면상적신경속분포정황;석사포매절편,행Loyez수초염색법염색,응용도상분석계통대조직절편진행정량분석:측산각신경단면유수신경섬유수목、신경속절면적화신경간절면적,계산신경속화결체조직소점비례병채용배대양본t검험.결과 저배경하고박기기지신경속대다수신경섬유정현매활성반응,유소량희소적괴상매염구.고배경하신경섬유형태청석가견,축돌염색,수초급주위결체조직불염색.응용Loyez수초염색법현시단면유수신경섬유,통과도상분석계통,능구측산신경분지급각단면적신경섬유수목화결체조직면적등지표.고박기신경유수신경섬유수위(1958±375)근.전、후지유수신경섬유수,전、후지절면적차이균유통계학의의,P＜ 0.05,후지적신경섬유수화절면적대우전지.고박기신경간상각개평면지간결체조직면적차이균유통계학의의(P＜0.05),결체조직소점비례향원단축점증가,이신경속소점비례적변화추세화결체조직상반.결론 응용AchE조직화학염색방법,고박기신경운동속적특정청석가변,결합현미해부결과,능구명학고박기신경속적주행급분포정황.응용Loyez수초염색법통과정량분석가명학신경섬유수,유조우선택합괄적공체신경,보증량문합신경지간체도상호필배.
Objective To provide histology base for the microsurgical repair of the free gracilis muscle transplantation after brachial plexus.Methods Totally 6 fresh male adult cadaveric inferior extremities were obtained.The gracilis muscle nerve were exposed and divided with the microdissection.Specimens were got from different segment after marked direction.All specimens was faced in 4％ formaldehyde solution and then crossing sections were cut by cryoultramicrotome.All slides were stained use the technique of Kamovsky-Roots AchE histochemical.The result of never tissue staining and the distribution of individual functional fascicular group were observed on each cross-section.According to the result of staining combined with the microdissection and the order of different branches branching off the nerve trunk,the distribution of individual functional fascicular group were observed on each cross-section.The 5 μm-thick routine waxed crossing sections were made and stained according to the myelin technique of Loyez.These histological sections were analyzed by using image analysis system.For each histological section,the number of the medullated nerve fibers and the section areas of the each nerve tracts and trunks were measured and calculated.Then the proportion of nerve tracts and connective tissue were calculated.The proportion of each connective tissue was adopting paired-samples t test.Results Under low power lens most of the gracilis muscle nerve were positive reaction,only a few sparse block-shape enzyme staining regions were shown.Under high power lens,the gracilis muscle nerve have clear outline,enzyme staining limited at neuraxis,no staining at myelin sheath and connective tissue.Quantitative analysis shows that the total myelinated fiberscilis nerve was about (1958 ± 375) radix.The branches arising from the posterior subdivision were more than that from the anterior (P =0.000).There were statistical difference between the number of the medullated nerve fibers and the section areas of the anterior and posterior subdivisions,the posterior subdivision were more than that of the anterior (P ＜ 0.05).There also had statistical difference between different section areas of the connective tissue in the gracilis nerve trunk (P ＜ 0.05),the section areas of the connective tissue of the distal were more than that of proximate.Conclusions The motor fascicles characteristic of the gracilis muscle nerve can be distinguished clearly by using AchE histochemical staining,combin with the microanatomy results,we can gain the distribution of the fascicular groups on each crossing sections.Using Loyez staining and quantitative analysis,we can ensure the number of the medullated nerve fibers.It is helpful to select the suitable donor nerve and ensure the dialyneury matching each other.