家犬双侧环杓后肌失神经及颈袢神经再支配后肌卫星细胞活性变化

Objective To investigate the activity of bilateral posterior cricoarytenoid muscle satellite cell after denervation or reinnervation with ansa cervicalis. Methods Twenty four dogs were randomly divided into 3 groups. The bilateral laryngeal recurrent nerves were cut in group one in all dogs. The bilateral laryngeal recurrent nerves were anastomosed with ansa cervicalis after incision in group two in all dogs. The dogs in group three were used as control. Nine weeks after surgery, the electromyography was used to test the regeneration of the nerve. The posterior cricoarytenoid muscles biopsy were collected. The expression of mRNA of Myogenin, Myf5, and Pax7 was assayed by realtime RT-PCR after total RNA isolation. Results Two dogs died after surgery in incision and anastomose group. The electromyography suggested that the RLN of all dogs had denervated in the incision group and had reinnervated in the anastomose group after 9 weeks. Myogenin mRNA from RLN incision dogs PCA muscles had greater expression versus controls ( Z = 1.42, P ＜ 0. 01 ) or anastomosed dogs ( Z = 1.38, P ＜ 0. 01 ). Myf5 mRNA expression from RLN incision dogs PCA muscles had significant increase versus control dogs ( Z = 1.66, P ＜0. 01 ) or anastomosed dogs ( Z = 1.69, P ＜ 0. 01 ). Pax7 mRNA expression from RNL incision dogs had significant increase compared with control ( Z = 1.66, P ＜0. 01 ) or anastomosed animals ( Z = 1.42, P ＜0. 05 ). There was no significant difference in Myogenin ( Z = 1.34, P ＞ 0. 05 ), Myf5 ( Z = 0. 54, P ＞0. 05) and Pax ( Z = 0. 54, P ＞ 0. 05 ) mRNA expression between controls and anastomosed animals.Conclusions The bilateral denervation of RLN cause significantly increasing in dog PCA muscle satellite cell proliferation and differentiation. The bilateral reinnervation of RLN cause PCA muscle satellite cell come back nonproliferative, quiescent state in dog.     

实验性狗环杓后肌神经移植后的功能效果

本研究旨在比较一组巳行喉返神经切断和各种类型环杓后肌神经移植的狗所取得的功能效果。作者行喉返神经端对端吻合,即神经自身吻合6例;支配胸骨甲状肌的颈神经袢与喉返神经吻合5例;膈神经与喉返神经吻合5例。除3例神经自身吻合外,所有实验狗的喉返神经内收肌支均予切断,结扎两断端。依神经再生距离的不同,于手术后3～4月(神经自身     

环杓后肌延期神经再支配后收缩特性的定量分析

为观察延期神经再支配环杓后肌的收缩特性，比较不同神经再支配方法的疗效，我们选择２４只犬，在右喉返神经切断后，于即刻，４，６，８，１０和１２个月时，分别以２只犬行选择性膈神经与喉返神经吻合（切断内收肌支）支配右环杓后肌（神经吻合组）；另１２只犬分别以２只行颈袢胸骨甲状肌蒂植入右环杓后肌（神经植入组）。组后饲养６个月，测定环杓后肌收缩强度及时间。结果表明，两组术侧的环杓后肌收缩力恢复率随病程延长而下降     

不同延期神经再支配环杓后肌方法的疗效观察

目的：探讨环杓后肌延期神经再支配的方法及时机。方法：将２９只狗分成三组，两个实验组在喉返神经切断后即刻、４、６、８、１０、１２个月分别将膈神经与喉返神经吻合选择性支配环杓后肌和颈袢神经—胸骨甲状肌蒂植入环杓后肌，对照组喉返神经切断后各时间不作任何手术。结果：两个实验组６个月后行喉镜、神经肌电及肌收缩力、组织化学证实：神经吻合组各时间效果明显好于神经肌蒂植入组，但两种术式疗效均随病程延长而下降。结论：神经吻合法延期神经再支配环杓后肌６个月内效果较好，而神经肌蒂植入法治疗环杓后肌麻痹最好不晚于失神经后４个月，否则效果不佳     

犬环杓后肌电起搏参数

双侧喉返神经(RLN)损伤可致气道梗阻,选择性切除喉内组织或声带外移恢复呼吸功能的几种手术均不太理想。有报道对喉返神经麻痹采用电刺激喉内肌改善喉功能,但电起搏的许多参数尚不清楚,作者介绍一组试验并确定一组参数。将杂种成年犬分成两组,Ⅰ组RLN紧急切断术(对照组),Ⅱ组RLN切断加静脉注射巴夫龙(0.1mg/kg),旨在消除对神经的直接刺激。分离暴露环杓后肌(PCA),将两个特制的针电极间距2mm平行插入PCA,垂直于肌纤维,电极间所产生的椭圆形电场与肌纤维     

功能性电刺激失神经环杓后肌的动态研究

为了研究电起搏器对失神经后不同时期环杓后肌的作用,我们选用14只狗分为喉返神经切断及吻合两组,分别在手术后即刻、2周、1、2、4、8、12个月进行观察,结果发现在神经切断及吻合即刻环杓后肌电刺激强度阈值较低(2伏),2周后达最高峰(7～10伏),4个月后,神经吻合组恢复到最初水平,神经切断组维持在6伏左右,并发现随病程延长环杓后肌萎缩加重.因此,电起搏器一定刺激强度在一定时间内对恢复萎缩环杓后肌的功能是有效的.     

不同延期神经再支配环杓的肌方法的疗效观察

探讨环杓后肌延期神经再支配的方法及时机。方法：将２９只狗分成三组，两个实验组在喉返神经切断后即刻、４、６、８、１０、１２个月分别将膈神经与喉返神经吻合选择性支配环杓后肌和颈袢神经一胸骨甲状肌蒂植入环杓后肌。     

环杓后肌失神经支配

环杓后肌作用为外展单侧声带,它由喉返神经支配,当此神经完全切断后导致声带旁正中位置固定。有多种恢复环杓后肌神经再支配的手术设计,尽管在临床上长期麻痹病人成功报道不少,但用神经肌肉蒂移植后失败也有一定数量报道,本文作者认为这与环杓后肌萎缩或疤痕组织替代有关。研究对象为三只成年狗,切断其一侧喉返神经后1月、6月、12月分别将狗处死,并作环杓后肌组织学检查,第一个狗的对侧声带作对照组。研究结果显示喉返神经切断一月后,切断侧环杓后肌的Ⅰ型纤     

去神经支配后大鼠环杓后肌不同类型肌纤维的mRNA表达

目的 研究去神经支配后大鼠环杓后肌不同类型肌纤维蛋白mRNA表达的变化.方法 以切除单侧喉返神经后40天的8只大鼠的环杓后肌作为研究对象,使用实时定量PCR方法测定环杓后肌胶原Ⅲ、肌纤维蛋白各亚型的mRNA表达,并与正常对照组相比较.结果 去神经支配40天的大鼠环杓后肌,各亚型纤维蛋白的重链mRNA表达与正常对照组比较差异无统计学意义.但是Ⅰ/ⅡB亚型纤维蛋白的mRNA表达的比值与对照组比较差异有统计学意义(P=0.018).结论 大鼠去神经支配40天时大鼠环杓后肌重链肌动蛋白Ⅰ/ⅡB亚型纤维mRNA表达的比值增加,提示该肌肉的收缩力有减弱的趋势.     

喉返神经-膈神经吻合术后声带外展肌的神经肌电图表现

目的研究声带外展肌-环杓后肌在喉返神经-膈神经吻合术前、后的神经肌电图表现。方法造成犬单侧喉返神经完全性损伤,即行单侧犬喉返神经-膈神经吻合术,对吻合术前、后同侧环杓后肌神经电图各项参数进行对比分析。结果吻合术前环杓后肌的神经电图表现为潜伏期1．26±0．86,神经传导速度15．08±0．47ms／s,幅值50．49±4．75mV。神经吻合术后4个月,环杓后肌神经电图出现清晰动作电波形,表现为潜伏期延长,传导速度减慢,动作电位峰-峰值明显减小。结论神经吻合术后4个月,出现环杓后肌肌纤维不同程度的神经再支配,但新生神经末稍终板数量及神经鞘膜之再生还未完全达到正常水平。     

神经肌蒂移植同时恢复麻痹声带内收及外展功能的实验研究

目的 探索一种能同时恢复麻痹声带内收及外展功能的治疗方法。方法 对狗一侧喉返神经及喉上神经运动支联合麻痹的喉内肌,采用颈袢胸骨甲状肌肌蒂移植于麻痹环杓后肌,颈袢甲状舌骨肌肌蒂移植于麻痹侧环杓侧肌作为实验组,并仅用颈袢胸骨甲状肌肌蒂移植于麻痹侧环杓后肌作为对照组。术前及术后４个月行声带录像、喉肌电图检测、组织学检查。结果术后４个月所有动物均不同程度地恢复了麻痹声带的生物功能。实验组术侧声带内运动明显     

Recurrent Nerve/Ansa Cervicalis Nerve Anastomosis: A Treatment Alternative in Unilateral Recurrent Nerve Paralysis

Sectioning of the right recurrent nerve was done in 5 mongrel dogs under general anaesthesia. The distal stump was anastomosed with the ansa cervicalis nerve branch to the sternothyroid muscle. Three to 5 months later the vocal cord movements during light and very light anaesthesia were videorecorded. Under light anaesthesia contraction and medial bulging of the reinnervated right vocal cord occurred in 4 of the dogs. Under very light anaesthesia there was also some adduction of the right vocal cord in these 4 dogs. The right recurrent nerve was then sectioned proximally to the anastomosis and stimulated electrically. In all 5 dogs we observed that electrical stimulation produced a strong adduction of the right vocal cord. Histochemistry of the right vocal and posterior cricoarytenoid muscles showed that reinnervation had taken place. The study indicates that in cases of unilateral vocal cord paralysis an anastomosis between the ansa cervicalis and the recurrent nerve will result in improved phonatory function of the affected vocal cord.     

Functional remobilization evaluation of the paralyzed vocal cord by end-to-side neurorrhaphy in rats

OBJECTIVE: To investigate the value of end-to-side neurorrhaphy to treat vocal cord paralysis. STUDY DESIGN: A prospective study evaluating the effects of end-to-side neurorrhaphy to treat vocal cord paralysis by means of fiberoptic laryngoscopy and nerve electromyography. METHODS: Thirty Sprague-Dawley rats were divided into experimental group 1, experimental group 2, and a control group randomly. Right recurrent laryngeal nerve (RLN) was incised, and the distal end of the RLN was anastomosed to the right phrenic nerve by end-to-side neurorrhaphy in experimental group 1 or by end-to-end nerve anastomosis in experimental group 2, respectively. The adductor nerve branch of the right RLN was incised and anastomosed to the proximal end of the right ansa cervicalis nerve by end-to-end nerve anastomosis. Fiberoptic laryngoscopy and nerve electromyography were used to examine the vocal cord movement and nerve regeneration. RESULTS: Three months after operation, this effect of end-to-side neurorrhaphy created a significant difference compared with the end-to-end nerve anastomosis (P < .05). The end-to-side neurorrhaphy did not lead to vocal cord movement compared with end-to-end nerve anastomosis. CONCLUSION: Vocal cord paralysis cannot be treated by this microsurgical technique.     

Recovery of inspiratory abduction of the paralyzed vocal cords after bilateral reinnervation of the cricoarytenoid muscles by one single branch of the phrenic nerve

The aim of this study was to provide the bilateral reinnervation of the posterior cricoarytenoid (PCA) muscles by the superior root of the right phrenic nerve. In six adult cats, the right phrenic root was anastomosed to the distal stump of the transected recurrent laryngeal nerve (RLN) on the same side. The RLN adductor branch was then cut and anastomosed to a nerve graft whose end was carried contralaterally and sutured to the left RLN or to the left PCA muscle. The phrenic fibers regrowing along the RLN abductor branch reinnervated the right PCA muscle and restored the inspiratory abduction of the right vocal cord in all the animals. In five of the six cats, the fibers regenerated through the RLN adductor branch and the graft reached the left PCA muscle and also restored the inspiratory opening of the larynx on the left side. Histological nerve examination revealed a fairly symmetrical distribution of the regenerated phrenic axons to the right and left PCA muscles.     

神经肌蒂移植术治疗声带麻痹的对比实验研究

目的;比较不同神经肌蒂环榴后肌移植术治疗声带麻痹的疗效,为临床选择术式提供参考。方法：建立联合性喉麻痹模型。分别用颈袢胸骨舌骨肌肌蒂（简称颈袢组）和副神经胸锁乳突肌肌蒂（简称副神经组）移植于环杓后肌,以恢复声外展功能,术后４个月,分别进行录音,直达喉镜和电视喉动态镜观察声带运动并录像,喉肌电图检查,环榴后肌透射电子显射镜检查和酶组织化学检查,并进行电脑图像定量分析。结果：术后颈袢组和副神经组犬吠声     

A histochemical evaluation of experimentally reinnervated canine laryngeal muscles

Sixteen dogs underwent different types of experimental reinnervation procedures of the posterior cricoarytenoid (PCA) muscle - reinnervation by the recurrent nerve itself (self-reinnervation) (n = 6), by the ansa cervicalis nerve (n = 5) or by the phrenic nerve (n = 5). After functional evaluation the normal left and the reinnervated right PCA muscles were removed for histochemical analysis. Cryostat sections were incubated for actomyosin ATPase, NADH-TR and alpha-GPDH. All muscles showed microscopical evidence of successful reinnervation. There was a slight change in the muscle fiber type composition in the reinnervated muscle as compared to the normal side. Incubations for the NADH-TR and alpha-GPDH showed less staining intensity in the reinnervated muscles. The histochemical differences between normal and reinnervated muscles were small, however, and probably of minor importance with regard to the function of the muscles.     

Histochemical study of posterior cricoarytenoid muscle reinnervation by a nerve-muscle pedicle in the cat

Reinnervation of the posterior cricoarytenoid (PCA) muscle with a nerve-muscle pedicle (NMP) has been proposed for patients with bilateral abductor vocal cord paralysis. Since its success has been controversial, a glycogen depletion histochemical technique was used to examine reinnervation. An ansa cervicalis NMP was implanted into the denervated PCA in nine cats. Eight months later, vocal cord activity was evaluated. The NMP nerve was stimulated extensively in seven cats (experimental group). Optical densities of NMP-supplied PCA muscle fibers from experimental and control groups were compared to detect differences in glycogen content. The results demonstrated quantitative evidence of reinnervation in two experimental animals. Electrical stimulation of the NMP produced abduction in one of these two animals, but was never observed during spontaneous respiration or airway occlusion. These observations indicate that reinnervation can occur but abduction requires electrical stimulation. The NMP technique may be more successful with an electrical pacer.     

Study on contractile properties of the posterior cricoarytenoid muscle after delayed reinnervation]

To study date on the contractile properties of posterior cricoarytenoid muscle after delayed reinnervation of different reinnervated methods. Twenty four dogs were reinnervated at 0,4,5,6,10 and 12 month interval following recurrent laryngeal nerve via the phrenic nerve anastomosed to the recurrent laryngeal nerve after cutting the adductor branch and ansa cervicalis-sternothyroid muscle pedicle implanted into the posterior cricoarytenoid muscle. After 6 months, a series of contractions were recorded from each side in twenty living dogs. The results showed that contractile force of reinnervated muscle decreased gradually with the time of denervation, but contractile force of muscle was no significantly difference between reinnervated side of nerve anastomosed group in 4 months after denervated and normal side, and it was significantly difference between nerve anastomosed group and nerve-muscle pedicle implanted group at some time of delayed reinnervation. The contractile time of reinnervated side of two operated groups was similar to that of normal side. The conclusion demonstrated that the contractile properties can indicate exactly reinnervated degree of muscle, and the earlier reinnervation was performed, the better curative effect was.     

Newer technique of laryngeal reinnervation: superior laryngeal nerve (motor branch) as a driver of the posterior cricoarytenoid muscle

This report analyzes the experience gained using two different techniques to reinnervate the paralyzed vocal cord. In the neurotization group, the superior laryngeal nerve (SLN) motor branch-cricothyroid muscle pedicle was used to reinnervate the posterior cricoarytenoid muscle. In the direct nerve anastomosis group, the SLN was anastomosed to the abductor branch of the recurrent laryngeal nerve (RLN), and the ansa hypoglossi (AH) to the adductor branch of the RLN. A third group of animals (control) had the right RLN sectioned without any anastomosis. About 5 to 6 months postoperatively the animals were killed painlessly and evaluated. The neurotization group revealed vocal fold mobilization on the right side to have an average of about half of the mobility of the left, normal side. After the RLN and SLN on the left were severed as well as the AH bilaterally, the vocal cord mobility was reduced to about one fourth. The direct nerve anastomosis group showed about fourfold less vocal cord mobility than the neurotization group. After the SLN, RLN, and AH were severed bilaterally, the control group showed no vocal cord mobility. The neurotization technique has been selected for further experimentation in human adults.