用骨骼肌桥接神经缺损的灵长类动物实验研究

用两种形式的骨骼骨移植体即带蒂骨髂肌和植入血管的变性骨髂肌桥接灵长类动物猕猴尺神经3cm的缺损，并与自体腓肠神经移植进行比较，采用电生理和组织学定量的研究方法，经10个月观察，示涌证实再生神经长过带蒂骨骼肌桥，神经于近端形成较大神经瘤、轴突延伸不到肌桥中段。面植入血管的变性肌桥与自体腓肠神经移植比较，两组的运动神经传导速度、复合动作电位幅值和面积积分、神经纤维密度差异无显著性，但前者移植体中段神经纤维成熟程度较差。     

神经疏导与重建神经连续性预防及治疗神经瘤性残端痛

目的探讨从预防神经瘤形成入手来治疗手及肢体神经瘤性残端痛。方法分别采用SD大鼠30只及Wister大鼠30只,进行神经肌腱缝合及神经骨骼肌桥接。术后16周进行大体解剖学观察及组织学检测。在临床上对残指(肢)神经瘤性残端痛进行神经肌腱缝合50例,神经肌肉桥接3例,静脉桥接77例,神经原位移植73例,神经断端直接缝合32例。结果动物实验:组织学检测结果,实验组无神经瘤形成,再生神经在肌纤维间或肌腱纤维间排列有序;对照组均有神经瘤形成。临床235例结果,优206例,良14例,可15例,优良率超过90%。结论神经瘤性残端痛因残端神经失去了正常的连续性形成神经瘤而引起疼痛。采用神经疏导及重建神经连续性的方法,从预防神经瘤形成入手;从病因学及临床结果分析,合理有效、值得推广应用。     

神经肌腱缝合治疗神经瘤性残端痛的实验研究与临床应用

目的 探讨治疗神经瘤性残端痛的一种新方法。方法 取SD大鼠30只，按手术先后随机分成2组，每组15只。实验组：切断一侧的坐骨神经，将其近端与同时切断的同侧跟腱近端缝合。对照组：将一侧坐骨神经切除1．0cm。分别于术后4、8、12、16周4个时间组，取材作组织学观察。临床应用该法治疗50例手指神经瘤性残端痛。结果 光镜观察，实验组缝合口处无神经瘤形成，再生的神经纤维在腱纤维间隙内生长，排列有序。对照组均有神经瘤形成。术后50例中失访4例，46例随访6个月～2年，按中日联谊医院的评定标准评定优良率为91％。结论 神经肌腱缝合法是一种有效的治疗神经瘤性残端痛的新方法。     

神经断端肌内埋入防治残端神经瘤的实验研究

周围神经切断端发生神经瘤是周围神经损伤的常见并发症，约１０％患者有顽固性疼痛。为研究神经断端肌内埋入防治残端神经瘤的机理，选用ＳＤ大白鼠１６只，将双侧坐骨神经切断后，左侧神经断端肌内埋入为实验侧，右侧神经断端自然回缩不作处理为对照侧，运用组织学和电生理学检测。结果表明，对照侧的神经近端在术后１个月就有神经瘤形成，而实验侧其神经断端的神经纤维分散长入肌纤维间，无明确的神经瘤形成。说明，神经断端肌内埋入可以防治残端神经瘤形成。     

外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛

目的探讨外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛的临床疗效.方法对56例外伤性神经瘤患者采用神经瘤切除静脉桥接手术.结果56例均获随访，时间3～18个月.参照尹维田等标准评定疗效：优45例，良7例，可4例，优良率为92．8％。结论采用静脉桥接治疗神经瘤性残端痛，可恢复神经连续性，预防神经瘤的再形成，临床效果确切.     

神经残端埋入腱鞘治疗指残端神经瘤

神经残端埋入腱鞘治疗指残端神经瘤宋修军曲永明刘远征引起手指残端痛的残端神经瘤，其治疗方法较多，如神经瘤切除松解，神经残端植入肌肉或植入骨内，硅胶帽包裹神经残端，神经中枢端相互吻合，静脉桥接或皮瓣静脉与神经残端吻合等手术。这些手术治疗机理不同，效果不一...     

神经断端肌同埋入防治残端神经瘤的实验研究

周围神经切断端发生神经瘤是周围神经损伤的常见并发症，经１０％患者有顽固性疼痛。为研究神经断端肌内埋入防治残端神经瘤的机理，选用ＳＤ大白鼠１６只，将双侧坐骨神经切断后，左则神经经断端肌内埋入为实验侧，右侧神经断端自然回缩不作处理为对照侧，运用组织学和电生理学检测。结果表明，对照侧的神经近端在术后１个月就有神经瘤形成，而实验侧其神经断端的神经纤维分散长入肌纤维间，无明确的神经瘤形成。说明，神经断端肌内     

残端痛性神经瘤

外伤或截肢 (指 )后的残端痛 ,相当一部分是因为局部形成了残端神经瘤。残端神经瘤可引起自发性疼痛、痛觉过敏或感觉异常等症状 ,并导致功能障碍。断裂的神经都会形成神经瘤 ,但仅有 10 %引起顽固性疼痛。残端痛性神经瘤在临床上较为常见 ,治疗方法较多但疗效不一 ,目前仍是周围神经领域中的一个重要课题[1] 。 1811年Ｏｄｉｅｒ首先描述了周围神经部分或完全切断后 ,近断端形成创伤性神经瘤 ;186 3年Ｖｉｓｃｈｏｗ根据神经瘤的组织结构分成真性神经瘤和假性神经瘤 ,认为残端神经瘤实际上是一种假性神经瘤[2 ] 。现就残端痛性神经瘤的形成…     

显微外科与冷冻技术联合防治痛性神经瘤形成

目的：探讨防治神经残端痛性神经瘤的新方法。方法：神经断面近端5－10mm范围接触液氮冷冻,在手术显微镜下操作进行神经束分离、包埋、结扎外膜封闭残端。临床应用共治疗58例（肢、指）,93条神经残端。结果：术后获得6－36个月随访的43例（肢、指）,67条神经,没有痛性神经瘤发生。结论：神经残端冷冻及显微外科联合应用,对防治痛性神经瘤形成有较好的效果。     

不同骨骼肌桥接动物神经缺损的实验研究

用不同骨骼肌桥接神经，找出适宜神经再生的最佳肌肉。方法：用背最长肌，肱三头肌，缝芹肌及其颅，尾两侧部，桥接３７条狗和３０只兔正中神经和肌神经缺损２－３ｃｍ。术后不同时间切取桥接神经，并将它分成神经近段，肌桥段，神经远段及远，近端吻合口段５个部分。常规制成光，电镜标本进行观察及图象分析仪测定。     

Implantation of Nerve Stump Inside a Vein and a Muscle: Comparing Neuroma Formation in Rat

Among many techniques independently reported to manage neuroma formation, manipulation of the nerve stump inside muscle and vein is the most advantageous technique. This study aimed to enrich the basic data of macroscopic appearance and histo-pathology regarding which technique generates less neuroma: nerve stump implantation inside vein or inside muscle. An experimental study with posttest-only control-group design was conducted in 24 rats that were randomly arranged into 3 groups. One centimeter of the lateral branch of the right ischiadic nerve was cut. Group A served as the control group, where the proximal nerve stumps were left as they were after the excision; whereas the stumps of groups B and C were implanted inside muscles and veins, respectively. The samples were assessed with histologic examination after 4 weeks to measure the morphometric changes in the nerve endings. The data were statistically analyzed with t test. All rats healed uneventfully. No thrombosis was found within group C, and the stumps were free of neuroma formation. The muscle group formed smaller neuroma than the control group. Statistical analysis showed significant differences between the groups (P < 0.05). The outcome of nerve stump implantation inside the lumen of a vein is superior to the implantation inside a muscle in preventing neuroma formation.Key words: Amputation, Axons, Neuroma, Wound healingAmong many factors with a role in neuroma formation, local factors are the key. They include superficial location of the nerves, recurrent trauma, and infection.^1,2 There are many published surgical methods of nerve stump manipulation aimed at managing neuroma formation; they vary from excision, shortening the stump, sealing the stump with silicone, and implantation of the stump inside a vein, muscle, or bone, to suturing nerve to nerve in an end-to-side fashion.^1–10 Unfortunately, with regard to nerve stump management at the first surgery, the authors observed empirically that most surgeons only tie up the nerve stumps with threads without great concern on the future of potential painful neuroma formation.Among these many techniques, manipulation of the nerve stump inside muscle or vein is the most advantageous technique as it is easy to find adjacent muscle and vein; also, the techniques need no exogenous implant and are considered less-extensive procedures. However, to the best of the authors'' knowledge, there is only one clinical study comparing the treatment of painful neuroma between nerve stump translocation into muscle and into vein.¹¹ That study was in favor of the vein group, and it was conducted to measure clinical outcome without histopathologic study on the result of neuroma formation. This study, by comparison, is intended to enrich the basic data of macroscopic appearance and histopathology regarding which technique generates less neuroma: the nerve stump implantation inside a vein or inside a muscle. This study also aims to encourage surgeons to apply a simple and advantageous technique of nerve stump management to prevent the formation of painful neuroma.     

Reduction of post-traumatic neuroma and epineural scar formation in rat sciatic nerve by application of microcrystallic chitosan

Injury of peripheral nerve is associated with the development of post-traumatic neuroma at the end of the proximal stump, often being the origin of neuropathic pain. This type of pain is therapy-resistant and therefore extremely nagging for patients. We examined the influence of the microcrystallic chitosan gel applied to the proximal stump of totally transected sciatic nerve on the neuroma formation and neuropathic pain development in rats. In 14 rats, right sciatic nerve was transected and the distal stump was removed to avoid spontaneous rejoining. In the chitosan (experimental) group (n = 7), the proximal stump was covered with a thin layer of the microcrystallic chitosan gel. In control animals (n = 7), the cut nerve was left unsecured. Autotomy, an animal model of neuropathic pain, was monitored daily for 20 weeks following surgery. Then, the animals were perfused transcardially and the proximal stumps of sciatic nerves were dissected and subjected to histologic evaluation. The presence, size, and characteristics of neuromas as well as extraneural fibrosis were examined. In chitosan group, the incidence and the size of the neuroma were markedly reduced, as compared with the control group; however, there was no difference in autotomy behavior between groups. In addition, extraneural fibrosis was significantly reduced in chitosan group when compared to the control group. The results demonstrate beneficial influence of microcrystallic chitosan applied to the site of nerve transection on the development of post-traumatic neuroma and reduction of extraneural fibrosis, however without reduction of neuropathic pain.     

Prevention and treatment of painful neuromas of the superficial radial nerve by the end-to-side nerve repair concept: an experimental study and preliminary clinical experience

This article studies the utilization of the end-to-side neurorrhaphy concept in the prevention and treatment of painful neuromas. A total of 20 rats were divided into 2 groups (10 rats per group). In group A, the tibial nerve was divided and left lying in the subcutaneous tissue. In group B, the cut ends of the tibial nerve were sutured to the adjacent peroneal nerve in an end-to-side fashion. Evaluation was performed 90 days after nerve injury. For group A, the proximal end of the tibial nerve formed a "classic" neuroma and the distal end showed a degenerated nerve. In group B, the proximal end of the tibial nerve formed a "non-classic" neuroma and the nerve healed into the peroneal nerve with continuity of the epineurium of the 2 nerves. The distal end of the tibial nerve in group B showed evidence of axonal regeneration. Preliminary clinical experience utilizing the same technique in the prevention and treatment of painful neuromas of the superficial radial nerve is presented and other techniques of nerve-to-nerve implantation are discussed.     

Experimental study of bridging the peripheral nerve gap with skeletal muscle

A piece of skeletal muscle was used as a conduit to bridge the gap microsurgically between the two ends of the severed sciatic nerve in 30 rats, and a method for histochemical demonstration of acetylcholinesterase was employed to assess the nerve regeneration process 5 weeks or more after the operation. Regenerating nerve fibers were detected in the muscle and could be traced through to the distal stump of the severed sciatic nerve. This suggests that skeletal muscle might serve as a grafting conduit for the repairing of peripheral nerve injuries.     

内脏神经-体神经端侧吻合后神经纤维再生研究

目的 观察大鼠内脏神经-体神经端侧吻合后神经纤维的再生.方法 24只成年SD大鼠随机分为实验组(n=12)和正常对照组(n=12),实验组大鼠通过内脏神经-体神经端侧吻合建立人工体神经-内脏神经反射弧6个月后,在吻合口近端和远端分别截取10 mm的供体神经(L4VR)和受体神经(L6VR),在L6VR延续的盆副交感神经(PPN)和阴部神经(PN)分别截取10 mm的神经.正常对照组大鼠分别取相应节段的L4VR、L6VR、PPN和PN神经.标本经石蜡包埋切片并行甲苯胺蓝染色,比较实验组和对照组大鼠L6VR、PPN、PN神经纤维数量.结果 实验组大鼠横断面可见新生的有髓神经纤维,L4VR、L6VR、PPN和PN的神经纤维数量分别为1602.2±75.7、1037.9±123.6、817.0 ±52.2、510.4±29.1,吻合口远近端神经纤维通过率为64.8%,实验组和对照组大鼠相应的L6VR、PPN、PN神经纤维数目比率分别为70.2%、68.9%和62.2%.结论 大鼠内脏神经-体神经端侧吻合后体神经能够长入并替代内脏神经.     

神经干细胞移植防治骨骼肌失神经肌萎缩的电生理研究

目的探讨采用神经干细胞移植的方法防治骨骼肌失神经萎缩的可行性。方法采用机械分离的方法从孕14～16 d的SD孕鼠中获取神经干细胞,并于神经元限定性培养基中进行传代培养,制备神经干细胞单细胞悬液。采用切断右侧胫神经的方法建立腓肠肌失神经支配的动物(SD大鼠)模型。将108只SD大鼠按注射药物的不同随机分为3组,每组36只大鼠。实验组:将神经干细胞悬液注射到切断的胫神经远端。损伤组:注射等量的生理盐水。对照组:注射等量的细胞培养液。术后8、12周采用HRP逆行示踪技术检测失神经骨骼肌重获神经再支配的情况,并应用肌肉电生理方法对重获神经再支配的骨骼肌进行功能评价。结果术后8、12周实验组用电刺激细胞移植部位的腓肠肌,均可引出肌肉收缩活动;且随着时间的延长,单次收缩的波幅、速度,和强直收缩的时间和强直收缩波幅的恢复率均进一步得到改善。对照组和损伤组均未能引出肌肉活动。结论神经干细胞移植能够实现失神经骨骼肌的神经再支配,并且能够与骨骼肌建立起功能性突触连接,有效预防骨骼肌的萎缩。     

End-to-side neurorrhaphy supported by transposed active nerve fibers: its functional end result in a rat model

 End-to-side nerve repair is an old-fashioned technique which has been abandoned since the beginning of this century. Recently, new treatment modalities have been investigated to overcome problems associated with peripheral nerve injury where the proximal stumps are not available. In this study, 30 rats were divided into three groups. In the first group the peroneal nerves were sectioned and their distal ends were sutured to the tibial nerve trunk. In the second group, the proximal part of the peroneal nerve was similarly sutured to the tibial trunk. A primary end-to-end neurorrhaphy performed on the peroneal nerves was the control group. At 2, 4, 8, 12, 20, and 28 weeks, functional assessment of nerve regeneration was performed using walking track analysis. The number of myelinated fibers and fiber diameters were measured, and an electron microscopic evaluation was carried out. With morphometric analysis, the values were significantly different in favor of the control group following the end-to-side repair technique. But, according to gait analysis, both groups had a similar satisfactory functional recovery; the classic end-to-side repair group had an unsatisfactory result. It is concluded that end-to-side neurorrhaphy, supported by transposed active nerve fibers, may result in a good integration network at the repair site and is a possible functional reconstruction model where the proximal stump is not available after peripheral nerve injury. Received: 23 September 1996 / Accepted: 24 March 1997