周围神经卡压外膜松解范围对手术疗效影响的实验研究

目的研究神经外膜松解范围对手术疗效的影响。方法取SD大白鼠96只,采用大鼠坐骨神经慢性卡压模型,根据神经外膜松解范围的不同将实验分为6组。A组卡压段外膜纵向切开0 .3cm ,神经外膜下向两侧分离1/2。B组卡压段外膜切除1/2。C组卡压段外膜全部切除。D组以卡压段为中心外膜纵向切开0 .9cm ,神经外膜下向两侧分离1/2。E组以卡压段为中心切除0 .9cm一段外膜的1/2。F组以卡压段为中心外膜全部切除0 .9cm。术后分别于4、6、8、10周进行肌电图和组织学检查。结果与其它各组比较,D组的神经传导速度恢复最快(P <0 .0 1) ,有髓神经纤维最多,变性的神经纤维最少(P <0 .0 1) ,髓鞘发育最成熟,神经内血管增生最明显。结论单纯神经外膜纵向充分切开并向两侧分离1/2松解术,既能有效解除压迫,又最大限度地保存了神经外膜的连续性和血供,疗效最好。

Influence of extent of epineurectomy on the results of neurolysis in nerve entrapment: an experimental study

Objective To investigate the relationship between the extent of epineurectomy in neurolysis of peripheral nerve entrapment and the surgical outcomes. Methods Chronic compression of the sciatic nerve was created in 96 healthy female SD rats. Epineurectomy of various extent was done according to group assignment. Electrophysiological testing and histological examination were carried out 4, 6, 8, and 10 weeks following neurolysis, respectively. Results Best results were seen in the group where epineurium of the compression segment was incised longitudinally for 0.9 cm and undermined to 1/2 of the circumference. Comparing to other groups, fastest nerve conduction velocity, largest number of myelinated nerve fibers, most mature myelin sheath structures, and most prominent neovascularization were seen. Conclusion Longitudinal incision of epineurium of the compression segment and circumferential excision to 1/2 on both sides leads to best neurolysis results in that it preserves continuity and blood supply of the epineurium in the process of complete decompression.