带蒂骨骼肌桥接近端周围神经防治残端痛性神经瘤的实验与临床应用研究

目的：探讨神经瘤的形成机制和致痛机制及周围神经与带蒂骨骼肌桥接吻合后神经的生长情况。方法：Wistar大白鼠40只随机分为实验组与对照组，两组均将左侧坐骨神经在适当水平切断，远端神经切除，实验组近端神经分为2束，用带蒂骨骼肌桥接2个神经断端，对照组近端神经置于原位。饲养16周进行组织学检测。临床应用此方法治疗残端痛性神经瘤24例。结果：实验组再生的神经纤维顺利通过吻合口长入骨骼肌桥内，并在肌桥的肌束内生长，分布于肌纤维之间，未见有神经瘤形成。对照组均有典型的神经瘤形成。临床24例病人总计36个神经瘤，随访6～20个月按中日联谊医院评定标准优良率为92％。结论：带蒂骨骼肌桥接近端周围神经是防治残端痛性神经瘤的一种简单、实用、有效的方法。

Experimental study and clinical application of proximal ends bridging of peripheral nerve with pedicled skeletal muscle to prevent and treat stump tenderness caused by neuroma

Objective:To investigate the mechanisms of painful neauroma formation and to observe the nerve regeneration of the bridged proximal ends of peripheral nerve with pedicled skeletal muscle.Methods:Forty Wistar rats were randomly divided into two groups,the experimental group and the control group.The left sciatic nerves of all rats were amputated at the same sites.The proximal end was longitudinally divided into two ends in each rat of experimental group,then bridged with pedicled skeletal muscle.The rats of the control group were not processed.Histological study was carried out after sixteen weeks.Twenty-four patients suffered from stump tenderness of the neuroma were treated by this method.Results:The regenerated nerve fibers grew into skeletal muscle and were well distributed among muscle fibers and no neuroma formed in experimental group.In all rats of control group,typical neuroma were observed.Thirty-six neuroma in twenty-four patients suffered from stump tenderness were treated by this method,and followed up ranging from six to twenty months,and the excellent and good rate was 92% according China-Japan Union Hospital Standard.Conclusion:Bridging between divided ends of proximal end of peripheral nerve with skeletal muscle is a simple,practical and effective way to prevent or treat painful neuroma with stump tenderness.