神经端侧吻合后侧支再生的形态学研究

目的 观察神经端侧吻合后未受损神经纤维侧支再生的情况。 方法 实验将Ｗｉｓｔａｒ大鼠一侧腓神经切断,在胫神经外膜上开一１ｍｍ小窗,将腓神经远端与胫神经作端侧吻合。术后３个月取吻合口处胫腓神经,用神经纤维分离技术分离出单根神经纤维,观察神经纤维生长方向;同时取远端腓神经作组织学检查和图像分析。 结果 在吻合口处可见到胫神经纤维发出侧芽,侧芽与胫神经伴行一段距离后呈“Ｙ”形分叉离开胫神经,侧支再生的纤     

大鼠神经端侧缝合的实验研究

目的：为进一步了解神经端侧缝合后再生的可能性。方法：用大鼠进行研究，实验分五组：Ａ组，将切断的腓神经远端与正常胫神经干行端侧缝合，保留缝合部胫神经外膜；Ｂ组，同Ａ组，缝合部胫神经外膜予以去除（“开窗”）；Ｃ组，将一神经移植段的两端分别与正常胫神经干和切断的腓神经远端神经干行“开窗”的端侧缝合；Ｄ组，将胫神经切断，近端与切断的腓神经远端神经干行“开窗”的端侧缝合。Ｅ组对照：仅切断腓神经。术后不同时期分别行电生理、组织学、神经纤维计数等检查。结果：鼠神经端侧缝合后腓神经远端有不同数量的有髓神经纤维再生。结论：动物鼠类神经端侧缝合能够再生     

大鼠腓总神经"π"式桥接于胫神经再生的原配连接

目的研究大鼠腓总神经被切断桥接于胫神经后，再生的腓总神经纤维的来源。方法将大鼠右侧腓总神经在胭窝处剪除约5mm后，将断裂的腓总神经近端和远端分别就近与同侧胫神经上的外膜窗施行端侧吻合，吻合口间距约10mm；动物存活24个月后，将手术侧近端吻合口以上胫神经剪断，再将辣根过氧化物酶注入远段腓总神经干内，72h后取材并经四甲基联苯胺显色显示脊髓L3-6节段神经元和L4、L5脊神经节细胞，同时取腓总神经远段行电镜观察神经纤维再生状态。结果远段腓总神经再生神经纤维清晰、明显，神经纤维比正常者略细；脊髓L3-6节段和L4、L5脊神经节均见到蓝染细胞。结论断裂腓总神经“π”式桥接于胫神经，至少有部分再生神经纤维经腓总神经近段来源于原配神经的胞体。     

端侧缝合后神经再生方式的实验研究

目的 应用组织学与荧光逆行追踪法研究端侧缝合后的神经再生方式。方法 雌性SD大鼠，共24只，实验分3组，分别为正常对照组、端端缝合组和端侧缝合组。3个月后，每组取2只，切取缝合口上下0．5cm的神经采用HE染色法进行缝合口形态学检查。另外6只大鼠，作为供体神经的胫神经用0．2％Diamidino Yellow，用作受体神经的腓总神经用0．2％True Blue进行逆行追踪。7～10d后经灌注取出大鼠L4～L6的DRG与相应的脊髓腰膨大进行荧光显微镜检测。结果 组织形态学观察可见端侧缝合组缝合口近端有神经轴突经侧方长人缝合口远端。同时可以看到胫神经的束膜保持一定的连续性。神经逆行追踪法中双标细胞出现在端侧缝合组L4～L6DRG（L4，L5DRG为主）及相应的脊髓腰膨大的切片中；端端缝合组、正常对照组相应部位仅可见单标细胞。端侧缝合组DRG双标细胞以中、小细胞为主。脊髓内以大细胞为主。结论 神经端侧缝合后神经的再生方式是侧枝芽生。再生纤维中既有感觉成分又有运动成分。感觉再生以痛觉为主。     

大鼠腓总神经“π”式桥接于胫神经后再生神经的电生理溯源

目的 研究大鼠胫神经原位桥接切断的腓总神经，观察腓总神经再生程度、神经纤维的来源等。方法 将断裂的腓总神经近端和远端分别就近与胫神经施行端侧吻合，存活18个月后，电生理检测再生神经纤维的动作电位传导，取腓总神经远段行光镜及电镜观察神经纤维再生数量及状态。结果 远段腓总神经有明显的神经纤维再生，远段腓总神经通过邻近神经的桥接与近段腓总神经之间有动作电位传导。结论 断裂腓总神经“π”式桥接于胫神经，部分再生神经纤维可能来源于原腓总神经近段，部分来自胫神经。     

端侧吻合与神经移植修复周围神经缺损疗效的形态学比较

目的：比较神经端侧吻合与神经移植修复神经缺损的疗效。方法：Wistar大白鼠20只,分两组,每组10只。右侧手术,切除腓总神经8mm。端侧吻合组近端反转结扎,远端与胫神经外膜开窗处行端侧吻合。神经移植组切取腓肠神经10mm,移植于腓总神经缺损处。两组动物左侧作正常对照。术后3个月,行双侧腓总神经、胫前肌组织学检查、胫前肌肌湿重测定及运动终板检查。结果：两组再生神经纤维数目、肌湿重、肌纤维截面积、运动产板的面积及着色均无显著性差异。结论：神经端侧吻合与神经移植修复神经缺损在形态学方面具有同等形态学疗效。     

神经端侧缝合再生的实验研究

目的：探讨神经端侧缝合术后神经的再生，为临床应用提供依据。方法：采用３０只大耳白兔，分６组。将右侧腓总神经切断，其远断端与胫神经行端侧缝合为实验组，切断远断端后不与胫神经缝合为对照组。术后进行电生理、组织学等观察。结果：可见胫神经侧支发芽长至腓总神经。结论：神经端侧缝合后侧支发芽支配与供神经无关的肌肉、皮肤     

不同剂量碱性成纤维细胞生长因子对神经侧枝再生的影响

目的: 探讨碱性成纤维细胞生长因子 (basicFibroblastGrowthFactor, bFGF) 能否促进神经端侧缝合后的侧枝再生, 其作用是否存在量效关系。方法: 15只Wistar大鼠随机分为A、B、C3组, 切断一侧腓总神经并将其远端与外膜开窗的胫神经做端侧缝合。A、B2组于术后 1周内每天在腹腔内注射生理盐水稀释的bFGF, A组剂量 4 000u/kg, B组剂量 2 000u/kg, C组注射等量生理盐水做对照。术后 3个月取缝合口远端的腓神经做组织学检查。结果: 应用bFGF后再生神经纤维数目、有髓纤维截面积和髓鞘截面积显著大于生理盐水对照组 (P<0. 05 ); 而A组上述三项指标均显著大于B组 (P<0. 05 )。结论: 神经端侧缝合后早期应用外源性bFGF可促进未受损神经的侧枝发芽, 其作用与剂量呈正相关。     

终末器官对端侧神经吻合后轴突再生影响的实验研究

目的探讨受神经远端终末器官对端侧吻合后神经再生的影响.方法 SD雌性大鼠10只,动物随机分为A、B2组.A组在近端切断腓总神经,其远断端与胫神经外膜开窗处进行端侧吻合; B组同 A组两神经端侧吻合后,在距吻合口1.5cm处切断其与终末器官的联系,并将连接肌肉的腓总神经远端反折固定在邻近的肌肉组织.术后12周取吻合口处的神经标本,甲苯胺蓝和抗神经微丝抗体免疫组化染色、光镜检查及图像分析.结果甲苯胺蓝染色及神经微丝免疫组化染色结果说明 A、B2组再生神经纤维数目、髓鞘厚度、纤维结缔组织含量及神经纤维丝排列,均有明显差异.结论终末器官对促进端侧神经吻合后神经再生具有重要作用.     

终末器官对端侧神经吻合后轴突再生影响的实验研究

目的 探讨受神经远端终末器官对端侧吻合后神经再生的影响。方法 SD雌性大鼠10只，动物随机分为A、B2组；A组；在近端切断腓总神经，其远断端与胫神经外膜开窗处进行端侧吻合；B组；同A组两神经端侧吻合后，在距吻合口1.5cm处切断其与终末器官的联系，并将连接肌肉的腓并且叫神经远端反折固定在邻近的肌肉组织，术后12周取吻合口处的神经标本，甲苯胺蓝和抗神经微丝抗体免疫组化染色，光镜检查及图像分析。结果 甲苯胺蓝染色及神经微丝免疫组化染色结果说明A、B2组再生神经纤维数目，髓鞘厚度，纤维结缔组织含量及神经纤维丝排列，均有明显差异。结论 终末器官对促进端侧神经吻合后神经再生具有重要作用。     

神经高位端端与低位端侧或侧侧缝合相结合提高神经修复能力的实验研究

目的对无缺损的周围神经高位损伤，提出高位端端与低位端侧或侧侧缝合相结合的新方法，观察神经再生和靶器官的恢复情况。方法SD大鼠80只，高位切断左侧胫神经。随机分为5组：A组：胫神经两断端行端端缝合，远端于膝关节水平与腓神经干行侧侧缝合。B组：断端处理同A组，远端移植正中神经作胫腓神经干之间的端侧桥接缝合。C组：单纯作断端的端端吻合。D组：胫神经干近端结扎并固定，远端与腓神经干行侧侧缝合。E组：近端处理同D组，远端切除部分神经段后，与腓神经干行端侧缝合。术后行肌电图检查及组织学观察并作统计学分析。结果术后早期（4周）D、E组有神经再生，术后12周A、B组的神经再生、传导功能及靶肌肉和运动终板的恢复情况均优于C、D、E组。结论高位端端与低位端侧或侧侧缝合相结合的方法，可尽早恢复对靶组织的营养和神经再支配，为高位缝合处高质量神经的长入赢得时间，提高了有效功能的恢复。     

End-to-side neurorrhaphy: an experimental study in rabbits

The concept of end-to-side nerve repair was recently introduced; however, most authors have reported conflicting results with this technique. This study was conducted to assess the effectiveness of end-to-side nerve repair in both fresh and predegenerated specimens by histological evaluation in an animal study in rabbits. Thirty male rabbits were divided into three groups. In group 1 (n = 14), the peroneal nerve was divided and sutured end-to-side to the tibial nerve via an epineurial window. In group 2 (n = 13), the peroneal nerve was divided and sutured end-to-side to the tibial nerve after a 1-week "predegeneration period." In group 3 (n = 3), which was considered the control group, the peroneal nerve was divided and sutured to the adjacent soft tissues. After 3 months, specimens were harvested for histological evaluation. Nerve fiber count, in normal peroneal nerves, averaged 532/cross section. In groups 1 and 2, average nerve fiber count in implanted peroneal nerves was 6.24 and 7.00/cross section, respectively. No significant statistical difference was observed between fresh and "predegenerated" groups (P = 0.90). These data suggest that collateral sprouting of donor nerves is possible after end-to-side neurorrhaphy through an epineurial window, but the number of nerve fibers in recipient nerves is too low to result in any functional recovery in the target organ.     

逆行追踪神经端侧缝合后侧支生长的神经元胞体实验研究

目的 探讨神经端事后侧支生长的神经远胞体来源。方法 将实验组端侧缝合的腓总神经距吻合口２．５ｃｍ外切断,其近端植入有辣根过氧化酶（ｈｏｒｓｅｒａｄｉｓｈ ｐｅｒｏｘｉｄａｓｅ,ＨＲＰ）的硅胶囊中,同法标记正常腓总神经与正赏胫神经近端。观察脊髓前角Ｌ７￣Ｓ２段及相应疹神经节。结果 对照组为正常腓总神经伸肌运动神经元核群;实验组标记细胞会布于正常总神经伸肌运动神经元核群的复内侧,与下沉胫神经标记细胞分     

Choline acetyltransferase activity in collateral sprouting of peripheral nerve after surgical intervention: experimental study in rats.

The purpose of this study was to establish an assay of choline acetyltransferase (ChAT) activity to investigate the regeneration of injured peripheral nerve, repaired by end-to-end or end-to-side neurorrhaphy. Murine sciatic and peroneal nerves were exposed, and the peroneal nerve was transected at a site 5 mm from its ramification. For end-to-side neurorrhaphy, an epineurotomy producing a 5-x5-mm window was carried out on the tibial nerve, just above the level of gastrocnemius muscle ramification. The peroneal nerve stump was then sutured end-to-side to the tibial nerve window. For end-to-end neurorrhaphy, the peroneal stump was directly sutured end-to-end. ChAT activity was measured at a site distal to the peroneal stump at 1 to 3 months postoperatively, and the results were compared among four groups: 1) end-to-end neurorrhaphy group; 2) end-to-side neurorrhaphy group; 3) unrepaired group; and 4) positive controls. ChAT activity in the end-to-side neurorrhaphy yielded approximately two-thirds the value of the end-to-end neurorrhaphy, and more than half the value of positive controls at 3 months postoperatively. Histologic sections of the end-to-side and end-to-end sutured peroneal nerve demonstrated large numbers of myelinated axons and Schwann cells at the third postoperative month. All the results demonstrated that end-to-side neurorrhaphy is comparable to well-performed end-to-end neurorrhaphy, thus providing another option for surgical treatment of avulsion nerve injury and massive nerve defect.     

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     

Schwann cells can induce collateral sprouting from intact axons: experimental study of end-to-side neurorrhaphy using a Y-chamber model.

Axonal regeneration across end-to-side neurorrhaphy has recently been reported; however, neither the mechanism by which collateral sprouting from intact axons is elicited, nor the origin of the regenerating axons are known. There has even been controversy over the presence of collateral axonal sprouting from intact axons altogether. This reported experimental study was designed to clarify these questions. A rat sciatic nerve model was used. To avoid any mechanical damage to the donor nerve during the procedure, a Y-shaped silicone chamber was employed instead of direct suture. Axonal regeneration from the intact tibial nerve across the gap into the peroneal nerve was assessed using a retrograde neurotracer and immunohistochemical staining. Axonal regeneration across the gap was observed in 66 percent of the animals. The neurotracer evaluation clearly showed that all regenerating axons were sensory axons from the dorsal root ganglia. The authors concluded that Schwann cells from the distal wallerian degeneration of nerve segments did elicit collateral axonal sprouting from intact sensory axons, but not from motor axons in end-to-side neurorrhaphy. Invasion of the Schwann cells into the epineurial layer was the crucial step for the initiation of collateral axonal sprouting from the intact axons.     

Effect of End-to-side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

Objective Neuroma is a psychologically and physically disabling problematic condition without any current standard therapy. For that reason, we investigated whether end-to-side anastomosis of the proximal end of the transected nerve into the adjacent nerve will prevent the development of neuroma in different types of nerve injuries. Study design In this study, hind legs of 18 Sprague–Dawley female rats were used. Six groups were formed. In group I, peroneal nerves were transected and its proximal end was attached end-to-side through the epineural window to the adjacent tibial nerve. In group II, contrary to group I, an epineural window was created in the tibial nerve and the same number of sutures were employed. In group III, tibial nerve was transected proximal to the end-to-side repair site, whereas in group IV, distal segment of the nerve was cut, and an end-to-end repair procedure was repeated. In group V, unlike group I, an approximately 1-cm segment was resected and removed distal (from tibial nerve) to the end-to-side repair site. In group VI, an epineural window was created in the tibial nerve and the same number of sutures were used, and also a 1-cm distal nerve segment was resected. The rats were followed for 2 months, and then all of the groups were evaluated histopathologically, and weights of the posterior muscle groups of hind legs were evaluated. Findings and Conclusions No neuroma formation was observed in the proximal stumps of peroneal nerve segments in end-to-side repair sites in groups I, III, IV, and V, and proximal stumps of the tibial nerve in group V. In group VI, neuroma formation was observed in the proximal end of the tibial nerve. When weights of the posterior muscle groups of hind legs in groups I and II were comparatively assessed, statistically significant difference was not detected. In conclusion, based on histological data obtained for proximal nerve ends and segments distal to the end-to-side repair sites, we think that end to side neurorrhaphy of the proximal end of the damaged nerve to adjacent nerve will prevent the development of neuroma without injuring the intact nerve segment.     

Motor functional and morphological findings following end-to-side neurorrhaphy in the rat model.

Nerve repair cannot always be achieved by the conventional end-to-end technique. This study evaluated the functional recovery of nerves repaired with end-to-side neurorrhaphy in a rat model. The right peroneal nerves of 80 female rats were transected and divided into four groups. In group A, the nerve ends were separated and remained unrepaired; in group B, the distal peroneal ends were directly sutured to the epineurium of the tibial nerves in end-to-side fashion; in group C, the distal ends were sutured through an epineurial window at the repair site in end-to-side fashion; and in group D, the nerve ends were reconnected by the traditional end-to-end technique. Evaluation included gait analysis by calculation of a peroneal functional index, measurement of contractile function of the extensor digitorum longus muscle, wet weight of the extensor digitorum longus, and histological examination. The findings of this study suggested the following: (a) end-to-side neurorrhaphy allows effective motor functional recovery, demonstrated by earlier improvement of the peroneal functional index, stronger muscle contractile function, greater muscle weight, and higher density of regenerated axons compared with unrepaired nerves; (b) removal of the epineurium of the donor nerve at the nerve coaptation site increases the effectiveness of end-to-side neurorrhaphy, but the epineurium appears to be a partial barrier to axonal regeneration; (c) removal of the epineurium does not affect the structure and function of the donor nerve; and (d) end-to-end repair achieved the best functional recovery among the four groups; therefore, end-to-side repair should be considered as a potential alternative only when no proximal nerve is available.     

终末器官对端侧神经吻合后轴突再生影响的实验研究

目的　探讨受神经远端终末器官对端侧吻合后神经再生的影响。方法　SD雌性大鼠 1 0只 ,动物随机分为A、B2组。A组 :在近端切断腓总神经 ,其远断端与胫神经外膜开窗处进行端侧吻合 ;B组 :同A组两神经端侧吻合后 ,在距吻合口 1 .5cm处切断其与终末器官的联系 ,并将连接肌肉的腓总神经远端反折固定在邻近的肌肉组织。术后 1 2周取吻合口处的神经标本 ,甲苯胺蓝和抗神经微丝抗体免疫组化染色、光镜检查及图像分析。结果　甲苯胺蓝染色及神经微丝免疫组化染色结果说明A、B2组再生神经纤维数目、髓鞘厚度、纤维结缔组织含量及神经纤维丝排列 ,均有明显差异。结论　终末器官对促进端侧神经吻合后神经再生具有重要作用