牵拉延长神经法修复周围神经缺损的实验研究

对１８只家兔双侧坐骨神经造成１０ｍｍ、１５ｍｍ和２０ｍｍ不同长度的缺损，以不同速度牵拉延长神经，修复缺损。左侧神经不置硅胶管，右侧远近段套入硅胶管内。用自行设计的体外式神经延长器，以每天１ｍｍ、２ｍｍ、３ｍｍ的不同速度，对神经远近段同时牵拉延长。延长后，外膜端端缝合。通过组织学和神经电生理观测，结果表明：神经在牵拉张力的作用下，能够获得有效延长。修复缺损后，神经的传导功能可以恢复。置硅胶管组的结果     

体外神经牵延器修复周围神经缺损的实验研究

目的：观察体外神经牵拉延长器修复兔周围神经缺损效果。为临床应用提供实验依据。方法：健康成年家兔36只，造成右侧坐骨神经缺损模型，随机分为神经牵拉延长组（12只）、神经游离移植组（12只）和神经端端吻合组（12只），术后每周观察动物一般情况，第12、16、20周神经电生理测定，第20周观察组织学变化。结果：神经牵拉延长器组神经功能恢复情况与神经游离移植组无明显差别，优于神经经端端吻合组。结论：神经牵延器体外缓慢延长修复周围神经缺损是可行的。     

应用神经延长架延长兔坐骨神经的实验研究

目的 利用神经延长器延长周围神经，修复周围神经缺损。为临床应用提供依据。方法 利用自制的神经延长架，每天分数次延长1mm，修复神经缺损10mm，9周后行电生理及组织学观察。结果 延长段神经外膜血供基本正常，神经缺损修复后其神经刺激阈值与神经原位缝合组差异无显著性，与神经移植组差异有显著性，组织学观察，延长组和原位缝合组有基本正常组织结构，神经移植组有明显空泡变性，髓鞘凝固变性。结论 应用神经延长装置，采用合适的连接方法，可有效的延长周围神经，修复神经缺损。     

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。     

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     

神经端侧缝合与神经转位缝合及带血运神经移植疗效比较的实验研究

目的 比较神经端侧缝合与神经转位缝合、带血运神经移植方法疗效的优劣。方法 健康兔24只,随机分成三组。A组为腓总神经远断端与胫神经端侧缝合;B组为胫神经近断端转位于腓总神经远断端缝合;C组将腓总神经制成6cm长带血运移植段原位缝合做电生理检查后取材,测肌湿重及组织学检查。结果 肌湿重、肌纤维横截面积、MCV、SCV显示A与B、A与c组间无显著性差异,B与C组间存在显著性差异;神经轴突再生显示A与B组间无显著性差异,B与C、A与c组间存在显著性差异。结论 神经端侧缝合后再生质量同神经转位缝合与长段带血运神经移植相比基本相同,但神经转住缝合优于带血运神经移植。     

神经“借干”修复周围神经缺损的实验研究

目的 探讨周围神经缺损的修复方法.方法 取SD雄性大鼠54只,切取右侧腓总神经10 mm,建立大鼠腓总神经缺损模型,随机分为3组,每组18只.A组为神经“借干”修复组,将腓总神经的远、近断端均修剪成45°斜面,在胫神经干相应外膜上开窗,分别行神经外膜端侧缝合;B组为远断端端侧缝合组,将腓总神经的近端结扎并翻转缝于邻近肌肉内,将腓总神经远断端修剪成45°斜面,相应胫神经干外膜开窗,行端侧缝合;C组为自体神经回植组(对照组),将切取的腓总神经原位回植.术后20周,对各组大鼠进行神经电生理和病理组织学检测.结果 术后20周,A组的神经传导速度、胫前肌复合动作电位、有髓神经纤维计数均优于B组(P＜0.05),与C组比较差异无统计学意义(P＞0.05).结论 对于大鼠周围神经缺损,神经“借干”修复方法是可行的.     

快速和缓慢面神经延长的实验研究

目的 对快速和缓慢面神经延长进行比较研究,验证快速面神经延长的可行,为临床应用神经处长术修复面神经缺损提供依据。方法 用自制的神经延长器以不同速度延长面神经颊支,快速延长组１０ｍｍ／１０ｍｉｎ,缓慢延长组１．５～２．０ｍｍ／ｄ,在不同时间点检测颊肌肌电图（ＥＭＧ）、神经传导速度（ＮＣＶ）,并观察神经的病理形态学改变,在延长结束后切除一再做端端外膜缝合,设神经移植组作为对照,自处长开始计时,第１５周     

提高对神经修复方法的认识

长期以来，对神经损伤的修复通常都是在神经断裂时采用端端缝合。如有神经缺损，则根据具体情况而定，缺损范围较小时，可采用适当游离两神经断端、改变关节位置、神经移位以及骨缩短等方法；缺损范围较大时，则采用自体神经移植予以修复，以保证在无张力下进行神经缝合。迄今为止，这些仍然是神经损伤最常用和最有效的修复方法。神经端侧缝合是将损伤神经的远侧缝合到邻近正常神经干的侧壁上，由正常的神经干形成侧支发芽，长入侧方缝合的损伤神经远侧内，使损伤神经的功能获得某种程度的恢复。早在１９０３年Balance即应用神经端侧缝合治…     

神经端侧缝合术后远期疗效的临床观察

目的 探讨周围神经断伤行端侧缝合术后的远期疗效。方法 对12例周围神经断伤作端侧缝合术。其中，前臂尺神经长段缺损3例，远断端与邻近正中神经干作端侧缝合；腓肠神经小腿中下段缺损7例，远断端与邻近腓浅神经干作端侧缝合；腓总神经膝上长段缺损2例，远断端与胫神经干在膝部作端侧缝合。对照组6例，皆为腓肠神经小腿中下段的缺损，远断端未作处理。术后连续随访3～5年。结果 缺损神经支配区感觉功能有所恢复，而运动功能恢复不明显。结论 神经端侧缝合后感觉功能有一定的恢复，运动功能恢复差，临床应谨慎选择使用。     

周围神经损伤远端延长修复自身缺损的实验研究

目的探讨能否利用损伤的神经远端延长法修复自身缺损。方法观察A组（即刻快速延长10%）、B1组、B2组（神经损伤2周后再行延长,延长率分别为10%、20%）神经耐受程度和恢复情况。结果A组平均延长（10.00±1.71）%,长度为（4.00±0.74）mm,神经传导速度恢复率(75.71±19.05)%、有髓神经纤维（NNF）再生率为(72.60±15.76)%;B1分别为（10.50±1.12）%、（4.20±0.44）mm、(82.08±4.76)%、(76.22±8.60)%;B2组分别为（21.40±4.03）%、（8.50±1.61）mm、(70.87±20.86)%、（64.67±12.42)%。即刻延长10%和损伤2周后快速延长10%、20%都有一定功能的恢复。结论变性周围神经的即刻延长在10%延长范围内耐受性好,而延长20%仍有再生,可以利用周围神经损伤远端即刻延长的方法来修复神经缺损。     

Distal nerve elongation vs nerve grafting in repairing segmental nerve defects in rabbits

Segmental nerve defects have been repaired with nerve grafts. However, regenerating fibers must go through two coaptation sites, and donor site morbidities are inevitable. We elongated the distal nerve segment using a tissue expander and reconnected the nerve. We compared these results with those of nerve grafting. Nerve injury models were created in the median nerves of both forelimbs in 27 rabbits. The right nerve was repaired by elongation, and the left by tibial nerve grafting. The length of the elongation was the same as that of the graft in each animal. Eight rabbits had a 10-mm segment repaired, 9 had a 15-mm segment repaired, and 10 had a 20-mm segment repaired. Evaluated outcomes were nerve conduction velocity, contractile force of the flexor muscle, axons number, and fiber diameter. The elongated and grafted groups did not differ substantially on any outcome. Distal nerve elongation could be an alternative to nerve grafting for repairing large nerve defects.     

联合运用冻融法和化学法去细胞同种异体神经修复兔面神经缺损

目的：通过对去细胞同种异体神经处理方法的改进,找出一种修复兔面神经缺损的理想替代材料。方法：取24只兔子,将兔左侧面神经上颊支切断以造成面神经缺损1.0cm的模型,根据修复方法不同,随机分成2组：实验组为联合运用冻融法和化学法去细胞同种异体神经修复组,对照组为自体面神倒置修复组,每组12只。术后3个月行大体观察、神经电生理检测、有髓神经纤维计数以及电镜观察,采用SPSS17.0软件包对数据进行t检验,对面神经恢复情况进行综合评价。结果：两组兔子均存活,切口愈合良好,兔面形基本对称;实验组与对照组左侧面神经上颊支传导速度分别为（55.74±10.56）m/s及（61.34±9.72）m/s,差异无显著性（P〉0.05）;实验组与对照组移植体远端吻合口邻近4.0mm段有髓神经纤维数量分别为（18173.62±918.38）n/mm2及（18601.21±982.31）n/mm2,差异亦无显著性（P〉0.05）;电镜检查结果相似。结论：联合运用冻融法和化学法去细胞同种异体神经能满意修复一定长度的面神经缺损,可以作为自体神经的一种有效替代物。     

Controlled expansion of peripheral nerves: comparison of nerve grafting and nerve expansion/repair for canine sciatic nerve defects

The inherent disadvantages of nerve grafting have made it necessary to find alternative techniques for treating segmental nerve loss. This study compares the techniques of nerve grafting and nerve expansion/repair for the management of nerve injuries with segmental nerve loss in an animal model. Bilateral segmental sciatic nerve defects were created in eight dogs. On one side a 2-cm segment was excised and replaced with a nerve graft; on the other side a 2-cm defect was created with ligatures and the nerve underwent preliminary expansion and then repair. Eighteen months later nerve conduction velocity (NCV), gastrocnemius contraction force (GCF), and muscle weight (GMW) were determined for the seven surviving animals. NCV for the expanded repair was 58.66 +/- 34.18 m/sec and 47.73 +/- 7.93 for the grafted repair (p = 0.4); GCF was 619.04 +/- 353.70 gm for the expanded repair and 726.80 +/- 415.78 gm (p = 0.2) for the grafted repair; and GMW was 82.80 +/- 5.68 gm for the expanded repair and 109.55 +/- 20.63 gm (p = 0.02) for the grafted repair. The data suggest that: 1) conventional tissue expansion techniques can be used successfully to repair segmental peripheral nerve defects; 2) NCV and GCF are comparable for grafting and expansion/repair techniques although GMW is significantly higher in the grafted group; and 3) nerve expansion/repair may prove to be a useful alternative to grafting.     

Proximal nerve elongation vs nerve grafting in repairing segmental nerve defects in rabbits

If segmental nerve defects could be repaired by elongating the proximal or distal segments, nerve grafting might be unnecessary. We elongated a 40-mm proximal segment of an injured median nerve, in the rabbit right forelimb, at a rate of 1 mm/day for 10 days in 10 rabbits and for 15 days in another 10. On the left forelimb of the same rabbits, a 10- for 15-mm segment of the median nerve was removed, and a 10- for 15-mm segment, respectively, of the tibial nerve was grafted in its place. Four months after the initial surgery, nerve conduction velocity (NCV), contractile strength of the flexor digitorum superficialis (FDS), axon count, and axon diameter did not differ significantly between the 10-mm groups but were better in the 15-mm grafted group. Elongating the proximal nerve segment may be an alternative to grafting in repairing segmental defects of less than 10 mm.     

优化法去细胞大鼠神经同种异体移植修复坐骨神经缺损

[目的]以优化法去细胞大鼠神经移植,修复同种异体坐骨神经缺损,观察术后动物的免疫排斥、早期功能恢复及神经再生情况。[方法]以优化去细胞方法处理新鲜取材的成年SD大鼠坐骨神经,移植修复同种异体1.0cm坐骨神经缺损,以自体神经和新鲜异体神经移植为对照,术后1个月行坐骨神经功能指数评价、神经电生理和组织学检查,观察动物在功能恢复、免疫排斥及神经再生方面的情况。[结果]自体神经和去细胞异体神经移植组动物的坐骨神经功能指数无显著差异(P>0.05),大体观察均可见神经连续性良好。电生理检测表明2组动物移植神经均已恢复电传导能力,在传导速度(CV)上无显著差异(P>0.05),但均未达到正常神经水平(P<0.05)。组织学观察则显示2组再生神经纤维均已长入移植段远端。S-100免疫组化显示两者在雪旺氏细胞数、形态和排列等方面无明显差异。2组在CD8 T细胞和巨噬细胞免疫组化染色阳性面积百分比上差异无统计学意义(P>0.05)。计算移植神经中段轴突密度后表明两者无显著差异(P>0.05),但都比正常神经小(P<0.05),比新鲜异体神经移植组大(P<0.05)。[结论]优化去细胞神经移植组与自体神经移植组在免疫排斥、功能恢复及神经再生方面无显著差异。优化法去细胞神经在移植修复同种异体神经缺损时,可以达到免疫耐受,其早期功能恢复和神经再生情况良好,在修复周围神经缺损时可以作为自体神经移植的一种替代疗法。     

周围神经缺损的牵引延长直接缝合治疗

周围神经缺损的修复方法很多，各有其优缺点。在组织扩张术及肢体延长术的启发下，设计了周围神经缓慢延长修复缺损后直接缝合的方法。临床应用２例，１例为肘部桡神经缺损７．２ｃｍ，另１例为肘部尺神经缺损５ｃｍ。１４天达到延长要求，修复了神经缺损。术后分别于１１９天及１４１天完全恢复了神经功能。经５年随访，患肢神经功能与健侧无差异。详细介绍了周围神经牵引延长的方法，预防结缔组织阻挡的措施，以及神经牵长的牵引力及着力点的设计等     

Effect of radiation on segmental distraction osteogenesis in rabbits

OBJECTIVE: To determine whether consolidation can occur during radiotherapy after segmental distraction osteogenesis. Segmental distraction osteogenesis has potential as a reconstructive option after oncologic resection of the mandible. However, postoperative radiotherapy has potentially deleterious effects on bone consolidation after distraction osteogenesis. METHODS: Tibial defects of 1.0 cm were created in 5 New Zealand white rabbits. After a 6-day latency phase, a 1.0-cm distraction segment was created in 0.3-mm increments every 12 hours. Within 24 hours of the distraction completion, the tibia received the biologic equivalent of 6000 rad (60 Gy). After 6 weeks of consolidation, the animals were humanely killed. Bone was analyzed radiographically, grossly (at autopsy), and histomorphometrically. RESULTS: Four rabbits completed the 6-week consolidation period. All specimens had evidence of calcified bone in the segmental defect on radiographic analysis. At autopsy, the volume of new bone equaled that of the removed segment. On histologic examination, the volume of new trabecular bone was similar to adjacent cortical bone. CONCLUSIONS: Consolidation of segmental distraction osteogenesis defects can occur in rabbit tibia during external beam radiotherapy. To our knowledge, this study is the first to demonstrate successful consolidation of segmental distraction osteogenesis during external beam radiotherapy.