应用端侧吻合方法治疗失神经肌肉萎缩的实验研究

目的 探讨应用端侧吻合方法防治失神经肌肉萎缩的作用,为临床治疗提供实验依据.方法 选用SD雌性大鼠作为研究对象,共32只,分为四组,每组8只.A组:将右侧腓总神经切断后,于相邻胫神经干上行外膜“开窗”,将腓总神经远侧断端以端侧吻合的方式吻合于胫神经干上.B组:将一神经移植段的两端分别与正常胫神经干和切断腓总神经远端行外膜“开窗”端侧吻合.C组:将右侧腓总神经切断后,两断端均结扎并翻转缝合于临近肌肉上.D组:正常对照组:大鼠右侧腓总神经不做任何处理.术后12周行神经肌肉形态学检查,胫前肌肌纤维横截面积,肌湿重及神经电生理检测,评价端侧吻合方法对失神经肌肉萎缩的防治作用.结果 ①神经肌肉形态学检查:A,B,D三组均可见再生的轴突和髓鞘,并且见正常肌肉形态结构,C组神经远断端纤维化并且肌纤维萎缩变细.②胫前肌肌纤维横截面积:A,B两组间差异无显著性(P＞0.05),C组与A,B,D三组比较,差异有显著意义(P＜0.05)③胫前肌肌湿重:A,B两组较D组稍轻,统计学上无显著差异(P＞0.05),C组与A,B,D三组比较,差异有显著意义(P＜0.01)④神经传导速度比较:C组测不出运动神经传导速度,A,B两组运动神经传导速度慢于D组,A,B两组间运动神经传导速度比较,无统计学意义(P＞0.05),A,B两组与D组比较,差异有统计学意义(P＜0.01).结论 端侧吻合法为防治肌肉失神经萎缩的有效方法,但其再生神经对肌肉支配功能不足以代替原支配神经.

End-to-side neurorrhaphy for prevention of atrophy in denervated muscles

Objective: To investigate the effect of end-to-side neurorrhaphy on prevention of atrophy in denervated muscles so as to provide the basis of the theory for the treatment of nerve defect in clinics.Methods: Thirty-two SD rats were used and randomly divided into four groups,with 8 in each.In Group A: the right common peroneal nerve was cut off,a window was made in the outer membrance of the tibial nerve stem,distal end of the common peroneal nerve and tibial nerve stem was religated by end-to-side anastomosis.In Group B: the right common peroneal nerve was cut off,the two ends of a nerve graft were sutured,end-to-side respectively with the windowed nornal tibial nerve trunk and the windowed trunk of the distal part of the severed peroneal nerve.In Group C: the right common peroneal nerve was cut off,the severed ends of peroneal nerve were kept apart by suuring them into neighbouring muscle.In Group D: the nerve was left intact as the control,the right common peroneal was intact.Twelve weeks after operation,the electrophysiological test was undertaken,the anterior tibial muscle and the nerve fiber was taken for histologic examination,anterior tibial muscle wet weight was measured.The cross section area of the anterior tibial muscle was measured so as to investigate the effect of end-to-side neurorrhaphy on prevention of atrophy in denervated muscles.Results: ①.The histologic examination of the anterior tibial muscle and the nerve fiber: the regenerate axone andmyelin sheath were seen in group A,B and D.The normal morphostructure of muscle was also seen.Fibrosis of the distal end the common peroneal nerve and atrophy of the muscle fiber in group C.② there was no significant difference on the cross section area of the anterior tibial muscle between Group A and B(P>0.05),but there was significant difference between Group C and Group A,B and D(P<0.05).③ There was no significant difference in the anterior tibial muscle wet weight between group A,B and D(P>0.05).But there was significant difference between Group C and Group A,B and D(P<0.01).④ The nerve conduction velocity was not recorded in Group C,the nerve conduction velocity of Group A and B was slower than that of Group D.There was no significant difference between Group A and B(P>0.05).But there was significant difference between GroupA,B and D(P<0.01).Conclusion: End-to-side neurorraphy is a valuable method of preventing atrophy of denervated muscles,but it can not replace the function of the original nerve.