大网膜包裹人工神经移植体再血管化及神经再生的研究

目的 探讨大网膜包裹人工神经移植体的早期再血管化，以及增强移植体血供对神经再生的影响。方法 75只大耳白兔制作成左前肢正中神经2．0cm缺损，随机分成3组：A组，带蒂大网膜包裹人工神经移植体移植；B组，人工神经移植体桥接神经缺损；C组，自体神经桥接神经缺损，作为对照组。术后3、7和14d应用伊凡思蓝（evans blue bound to albumin，EBA）毛细血管造影，检测各组移植体的再血管化；术后12周通过电生理、光镜、透射电镜等检测评估神经再生的效果。结果 A、C组术后3d移植神经出现再血管化，7d和14d再血管化程度逐渐增强；B组7d出现再血管化，与A、C组比较，再血管化延迟。术后12周，A组和C组运动神经传导速度、有髓神经纤维密度、神经内纤维组织面积及面积比、髓鞘厚度、髓鞘直径等差异无统计学意义（P〉0．05），但均优于B组，差异有统计学意义（P〈0．05）。结论 大网膜包裹人工神经移植体可促进移植体早期再血管化，增强移植体血供，促进神经再生。

AN EFFECT OF THE OMENTAL WRAPPING ON REVASCULARIZATION AND NERVE REGENERATION OF THE ARTIFICIAL NERVE GRAFT

Objective To explore an effect of the artificial nerve graft wrapped in the pedicled greater omentum on the early revascularization and an effect of the increased blood supply to the artificial nerve graft on the nerve regeneration. Methods Seventy-five rabbits were randomized into 3 groups, in which there were 2 experimental groups where the rabbits were made to abridge respectively with the artificial nerve grafts wrapped in the pedicled greater omentum (Group A) and with the artificial nerve grafts only (Group B), and the control group where the rabbits were abridged with the autologous nerve (Group C).On the 3rd, 7th and 14th days after operation, the evans blue bound to albumin (EBA) was injected into the vessels in all the grafts to show their revascularization. Twelve weeks after operation the nerve regeneration was evaluated with the electrophysiological and histological observations on the serial sections, and was evaluated also with the transmission electron microscope. Results The artificial nerve grafts wrapped in the pedicled greater omentum in Group A and the autologous nerve grafts in Group C showed a beginning of revascularization on the 3rd day after operation, and the revascularization was increased on the 7th and 14th days. Compared with Groups A and C, the artificial nerve grafts in Group B showed a delayed revascularization on the 7th day after operation. At 12 weeks after operation, there were no significant differences in the motor never conduction velocity, density of the regenerated myelinated nerve fibers, myelin sheath thickness, and diameter between Group A and Group C(P>0.05). However, both Group A and Group C were superior to Group B in the above variables, with significant differences(P<0.05). Conclusion Utilization of the pedicled greater omentum to wrap the artificial nerve grafts can promote an early revascularization of the artificial nerve graft and an early nerve regeneration of the artificial nerve graft because of an enhanced blood supply to the nerve graft.