膈神经端侧吻合移位治疗肌皮神经损伤的实验研究

目的 研究膈神经端侧吻合移位至肌皮神经治疗臂丛神经撕脱伤的可行性.方法 取雄性SD大鼠51只,随机分成4组:A组,单侧全臂丛神经撕脱组;B组,膈神经端端吻合组;C组,膈神经端侧吻合组;D组,膈神经螺旋状端侧吻合组(B、C、D组膈神经均移植2.0 cm腓肠神经至肌皮神经).并于术后进行肢体功能、组织学和神经电生理检测.另取绿色荧光蛋白(green fluorescent protein,GFP)转基因F344大鼠9只,通过荧光显微镜观察膈神经轴突再生情况.方果 各实验组术后手术侧肢体功能逐渐恢复,术后神经电生理和组织学检测表明,术后3个月,C、D组左侧肱二头肌肌张力恢复率和肌湿重恢复率,分别为B组的76.4%和86.3%、85.6%和87.7%,即端侧吻合组肱二头肌功能达到端端吻合组的80%以上,同时保留了膈肌的功能.荧光显微镜观察发现膈神经轴突通过端侧吻合口长入移植神经.方论 膈神经端侧吻合治疗臂丛神经损伤的手术方法是有效、可行的.

End-to-side neurorrhaphy for phrenic nerve neurotization of the musculocutaneous nerve in the treatment of brachial plexus injuries:an experimental study in rats

Objective To investigate the feasibility of end-to-side neurorrhaphy between the musculocutaneous nerve and the phrenic nerve for treatment of brachial plexus root avulsion injuries.Methods Fifty-one male Sprague-Dawley rats were randomly divided into four groups:total brachial plexus root avulsion(A),end-to-end neurorrhaphy for phrenic nerve neurotization of the musculocutaneous nerve(B),end-to-side neurorrhaphy for phrenic nerve neurotization of the musculocutaneous nerve(C),and helicoid fashion end-to-side neurorrhaphy for phrenic nerve neurotization of the musculocutaneous nerve(D).Another 9 rats expressing green fluorescent proteins(GFP+)were used for morphological observation of the regenerated nerve with fluorescence microscope.Evaluation of functional recovery including behavioral observation,histology detection and electrophysiology study were performed at intervals of 1,2 and 3 months after the surgery.Results Functional recovery of the injured forelimbs was observed in rats of all the groups except group A.Muscle force recovery rate and muscle weight recovery rate of group C and D reached 76.4% and 86.3% of those in group B and 85.6%and 87.7% of those in group B,respectively.Meanwhile function of the diaphragm was preserved.The fluorescence study revealed an abundant collateral sprouting of phrenic nerve axons originating from the site of coaptation to the distal end of the musculocutaneous nerve in all the experimental groups.Conclusion Although inferior to end-to-end neurotization,the standard end-to-side neurotization and end-to-side neurotization in helicoids fashion were effective methods,the latter resulting in better recovery.