内窥镜技术提高周围神经损伤疗效的实验研究

目的介绍应用内窥镜技术对神经缝合口再生质量早期作出准确判断及治疗的实验室依据。方法选用成年雄性比格犬12条,在月国窝上2cm切断坐骨神经后一期修复神经。术后用3种不同方法进行治疗,直至神经远端出现神经再生电位。A组(内窥镜手术组):术后2周起每周在内窥镜下作神经探查、松解术,检测缝合口远近端神经干动作电位(NAP)及电刺激治疗。B组(手术组):术后2周起每周在直视下进行与A组同样的手术、检测NAP和电刺激治疗。C组(保守治疗组):为对照组。术后观察动物功能恢复情况及定期进行电生理检查,观察小腿三头肌出现新生电位的时间。术后半年,手术探查神经缝合口情况,并行电生理检测。结果A、B2组在术后3周记录到神经新生电位已通过神经缝合口,术后6周于小腿三头肌记录到新生电位。C组于术后7周在小腿三头肌记录到新生电位。术后半年,A、B组的大体功能恢复,运动神经传导速度(MNCV)和复合肌肉动作电位(CMAP),其差异无统计学意义,但均优于C组(P<0.05)。结论应用内窥镜技术早期判断神经修复后神经再生的质量及治疗效果均明显优于保守治疗组,为临床应用提供了实验室依据。

Endoscopic intervention in management of peripheral nerve injuries: an experimental study

Objective The application of endoscopic techniques in early judgment of the quality of nerve coaptation was introduced. The effect of endoscopic intervention on nerve regeneration was also evaluated. Methods 12 male adult Beagle dogs were divided into 3 groups, with 4 each. Sciatic nerves were transected 2cm proximal to the popliteal fossa and sutured immediately. Postoperative management varied according to group assignment. In group A (endoscopic group) the repaired sciatic nerve was endoscopically explored to examine the suture site and record nerve action potential and nerve conduction velocity two weeks after the operation. Neurolysis and electric stimulation was also delivered via endoscope. The procedure was repeated once every week until neonatal potential was detected at the distal part of the sciatic nerve. The same procedures were followed in group B (surgical group) except that all was done in open surgery. In group C (control) there was no postoperative intervention. Functional recovery and electrophysiological changes were followed, and the time when neonatal potential of triceps muscle appeared was recorded. Six months after the operation, the quality of nerve coaptation was judged by surgical exploration and electrophysiological detection. Results Regeneration potential was detected distal to the nerve coaptation site 3 weeks after the operation in groups A and B. In group C, regeneration potential was present 4 weeks postoperationly. Neonatal potential of the triceps muscle was recorded 6 weeks post-op in groups A and B and 7 weeks post-op in group C. Hindlimb function almost recovered in groups A and B 6 months after the operation. There were no significant differences in motor nerve conduction velocity and compound muscle action potential between these two groups. Compared with group C, both of them were statistically better (P<0.05). Conclusion Endoscopic early detection of nerve suture quality and endoscopic intervention led to better nerve regeneration. The experimental results provided laboratory basis for potential clinical application.