化学去细胞同种异体神经移植物储存方法的初步研究

目的探索犬去细胞神经的最佳储存方法.方法采用真空封装辐照灭菌法深低温储存犬去细胞坐骨神经12个月,进行细菌学检查、一般组织学观察、免疫组化染色、透射电镜观察.结果储存过程中不会发生细菌污染,储存去细胞神经的延展性及神经外膜的韧弹性保持良好;其基本结构、神经基底膜及许旺细胞基底板层被保留;仍然保持为没有细胞髓鞘及其碎片的空的神经基质管.结论真空封装辐照灭菌法可有效储存去细胞神经1年.     

Cross-Facial Nerve Graft: A Report of Chronically Paralyzed Facial Muscle Neurotization by a Nerve Graft

A 21-year-old housewife with long-standing hemifacial paralysis on the left side decided to undergo the classic two-stage cross-facial nerve graft with muscle transfer. The first stage of the operation was performed successfully with the use of a sural nerve graft. After the appearance of Tinel’s sign 8 months later, gain of function in the muscles of the paralyzed side was observed and negated the need for the second-stage muscle transfer.     

粗大去细胞神经移植物的化学萃取及组织学研究

目的：发展新的化学处理方法，清除犬周围神经中的细胞和髓鞘，萃取粗大长段的去细胞神经移植物。方法：以Triton X-100和脱氧胆酸钠溶液化学处理犬坐骨神经，萃取神经行组织学及免疫组织化学观察。结果：去细胞神经弹性好，细胞和髓鞘被彻底清除，雪旺细胞基底板层保留完好，成为空的神经基质管。结论：该方法可有效清除大型哺乳类粗大神经的细胞及髓鞘，该神经移植物保持了网管柱状结构，保留了雪旺细胞基底板层及其主要成分一板层素。     

血管植入神经移植段修复周围神经缺损再血管化观察

将144只大白鼠随机分成三组,右侧坐骨神经造成10mm长神经缺损,分别用自体游离神经、自体游离神经+血管植入、带血管蒂神经桥接.术后于5天、10天、20天、30天、2月和3月取材,通过血管染色和墨汁灌注等方法观察各组再血管化过程.结果表明:血管植入方法与带血管蒂移植再血管化过程相似,明显优于单纯游离神经移植,并有简单易行、不牺牲供区主要血管等优点,为解决移植神经的血供提供了新的方法.     

Wide Resection of Traction Induced Radial Nerve Injury with Cable Grafting Leads to Full Recovery

The specific clinical setting of high-energy open humerus fractures combined with radial nerve transection has typically led to poor final outcomes with respect to recovery of nerve function. Attention has focused on the issue of an expanded zone of nerve injury induced by longitudinal traction. The fundamental principle of nerve grafting is to bypass the zone of injury. If direct repair or short nerve grafts are placed within the zone of injury, limited recovery should be expected, and this is exactly what has been documented. Wide resection of the zone of traction induced injury, particularly from the distal injured nerve trunk and replacement with long cable grafts has the potential for improved outcomes. Complete nerve recovery to 5/5 manual motor power testing and bilaterally equivalent grip strength is reported in two initial cases treated according to the wide resection plan.     

Results of Cable Graft Technique in Repair of Large Nerve Trunk Lesions

Summary  Cable grafting was reintroduced in the beginning of the 1980's as a modified method for repair of large polyfascicular nerves without group arrangement such as trunks and cords of the brachial plexus, sciatic nerve and its divisions, or the other main nerve trunks.  We used this method in 25 patients with brachial plexus injury and 29 patients with injuries to the sciatic nerve. Results were analyzed according to the individual nerve elements and were available for 32 elements of the brachial plexus and for 19 tibial and 19 peroneal divisions of the sciatic nerve. We defined useful functional recovery according to the priorities in repair of the brachial plexus and sciatic nerve with lower limits M3 for relevant muscles and functions and S2 for sensory function. Results were especially favourable for the brachial plexus with a total rate of recovery 84% and for tibial division with the same total rate of recovery.  On the basis of the results obtained we were able to conclude that the results of the modified cable grafting were at least similar to those of interfascicular nerve grafting and that this method could be useful for repair of large polyfascicular nerve trunks. However, the main advantage of this technique is a considerable gain in operative time.     

A Technique to Reconstruct a Nerve Injured at Its Bifurcation Site Using Autograft and End-to-Side Neurorrhaphy

Peripheral nerves injuries are relatively frequent after high-energy trauma in both upper and lower limb. This case report describes the reconstruction of a 5-cm nerve defect involving the superficial peroneal nerve (SPN) where it divides into its two terminal branches. A 5-cm nerve graft was harvested from the proximal part of the medial dorsal cutaneous nerve (MDN) and interposed to fill the gap between the distal stump of the SPN and the intermediate dorsal cutaneous nerve (IDN). The stump of the MDN was then sutured with an end-to-side (ETS) technique to the IDN, distally to the nerve graft, by opening a window in the epineurium of IDN. The sensory restoration of the dorsal area of the foot after 8 months was evaluated satisfactory from the authors. Tenderness and Tinel’s sign at the lesion site were not present. The patient’s satisfaction was excellent. The results of this case may suggest that a nerve defect involving a bifurcation point can be treated with satisfactory results using one distal stump as donor nerve for a nerve autograft to bridge the nerve gap followed by an ETS neurorrhaphy of donor one on the other stump. In this way, it is possible to reconstruct a bifurcation point by creating a new division point with the same Y-shape in a more distal position, without adding morbidity due to the harvesting of a nerve graft from another area of the body.     

腓肠神经移植重建海绵体神经保留勃起功能的实验研究

目的 :研究腓肠神经移植替代损伤的双侧海绵体神经恢复大鼠的勃起功能。　方法 :4 8只雄性SD大鼠 (3～ 4月龄和 30 0～ 4 0 0g)随机分为神经移植组、神经损伤组及假手术组 ,每组 16只。 2、4个月后 ,海绵体神经电刺激检测大鼠阴茎勃起功能 ,阴茎内注射神经逆行示踪剂荧光金 5d后检测盆神经节内被标记的神经元细胞。　结果 :2个月后神经移植组与神经损伤组大鼠对海绵体神经电刺激均无勃起反应 ,两组盆神经节内荧光金标记的神经元细胞数目差异有显著性 (P <0 .0 5 ) ;而 4个月后神经移植组大鼠勃起功能较神经损伤组差异有显著性 (P <0 .0 5 ) ,盆神经节内荧光金标记的神经元细胞数目也显著高于神经损伤组 (P <0 .0 5 ) ,与假手术组差异无显著性 (P >0 .0 5 )。　结论 :腓肠神经移植替代损伤的双侧海绵体神经可恢复大鼠的勃起功能。     

Reconstruction of Posterior Interosseous Nerve Injury Following Biceps Tendon Repair: Case Report and Cadaveric Study

Surgical repair of distal biceps tendon rupture is a technically challenging procedure that has the potential for devastating and permanently disabling complications. We report two cases of posterior interosseous nerve (PIN) injury following successful biceps tendon repair utilizing both the single-incision and two-incision approaches. We also describe our technique of posterior interosseous nerve repair using a medial antebrachial cutaneous nerve graft (MABC) and a new approach to the terminal branches of the posterior interosseous nerve that makes this reconstruction possible. Finally, we advocate consideration for identification of the posterior interosseous nerve prior to reattachment of the biceps tendon to the radial tuberosity.