周围神经移植修复脊髓损伤的实验研究

目的：探讨自体坐骨神经移植修复脊髓损伤的可行性。方法：将58只雌性Wistar大鼠分为二组，实验组：采用显微外科技术，将50只大鼠于T13水平切除左半侧脊髓10mm，再取右侧坐骨神经10mm移植到脊髓缺损处，近端接脊髓，远端接马尾，分别于术后2、4、6、8、12、22周在光镜和电镜下观察移植处坐骨神经、吻合口远端马尾神经、左后肢坐骨神经再生情况，并用摄像机记录患肢功能恢复情况。对照组：8只大鼠，于13水平切除左半侧脊髓10mm，不移植坐骨神经，观察脊髓缺损远端马尾神经和左右肢坐骨神经再生情况。结果：对照组坐骨神经的轴突及髓鞘部分崩解，密度降低，无再生轴突形成。实验组术后4周电镜下偶见移植处坐骨神经髓鞘及轴突形成，术后8周光镜及电镜下可见较多细的有髓神经纤维，22周时接近正常；同时观察到左后肢坐骨神经再生；大鼠后肢功能部分恢复，肌力达3级。结论：大鼠脊髓损伤后有再生能力，周围神经移植修复脊髓损伤是可行的。

The experimental study of the repair of spinal cord injury with peripheral nerve graft

Objective:To explore the practability of repair of spinal cord injury with sciatic nerve autograft.Method:58female Wistar rats were divided into two groups.The experimental group:By microsurgery technique,50rats' spinal cord were left-hemisected10mm at T13,the10mm right sciatic nerve were transplanted into the hemisection site,the proximal was connected with the spinal cord and the distal was connected with the cauda equina.Regeneration of transplanted sciatic nerve,distal cauda equina and the sciatic nerve of left hind-limb on the grafting side were observed by the light microscope and electron microscope respetively,in2,4,6,8,12,22weeks after operation.Meanwhile the motor function recovery of hind-limb was recorded by video-camera.8rats whose spinal cord were hemisected were chosen as the control group.Result:The axon and myeline sheath of sciatic nerve were partly lytic,density decreased,no regenerated axon formation in the control group.While in the experiment group:myeline sheath and axon formation of sciatic nerve in the grafting site were found by electron microscope in4weeks after operation,many thin myelinated nerve fibers was found by light microscope and electron microscope in8weeks,the grafting site was almost normal,sciatic nerve regeneration of the limb on the grafting side,motor function of hindlimb was improved and muscular strength restored to3grade in22weeks.Conclusion:The repair of spinal cord injury with peripheral nerve graft is practicable in the rat.