【文献解读】实验模型中神经端侧吻合术对早期的肌肉神经的再支配

【文献解读】实验模型中神经端侧吻合术对早期的肌肉神经的再支配
2017/11/12 创新医学网

     文章来源：欧尔意 OAE 微信号

     作者 :sofina

     原文出处

     Pérez A, Reynoso R, Romero RM, González A, Ochoa J, Gutiérrez DH, Palafox D. Early muscle reinnervation by means of end-to-side neurorrhaphy in an experimental model. Plast Aesthet Res 2017;4:18-23.

     DOI:10.20517/2347-9264.2016.95

     摘要

     目的：这项研究的目的是提供早期的肌肉神经再支配，以避免实验模型中肌肉的萎缩和功能的丧失。方法：将50只大鼠分开分成五组。第0组(对照组)中仅进行神经剥离。其余各组均行腓总神经切除。在第1组中，及时行端-端神经吻合(EEN)。在第2组中，从胫神经到腓总神经进行端-侧神经吻合(ESN)。在第3组中，直接EEN加上(ESN)作为神经移植物，并作为供体神经(胫骨)的桥梁; 所有的神经吻合都是通过一个神经外膜窗进行的。在第4组中，仅行神经切断术，没有任何类型的重建。结果：在第0，1和3组(38 ± 1mm，31 ± 6mm，32 ± 3mm)中，神经直径是相同的。与第0组相比，第3组神经纤维的轴突数目增加18%(P < 0.001)。第2组(28 ± 1mm)和第4组(19 ± 3mm)神经直径减小，肌肉再生指数较低。第4组的动物呈现“爪形”下肢并伴有行走困难。第2组和第3组的神经移植物直径相似(33 ± 3 mm，31 ± 3 mm)，但第3组轴突密度显著较高(53 ± 6 mm，39 ± 8 mm)(P < 0.001)。当EEN和ESN联合神经移植通过神经外膜窗时，轴突密度提高了3 6%。讨论：这项研究表明，EEN和ESN联合神经移植物为高度神经损伤的重建提供了一种低肌纤维破坏指数的可靠方法。

     关键词：神经传递，吻合，肌肉神经再支配，神经修复

     Aim:The aim of the study was to provide early muscular reinnervation to avoid muscle atrophy and functional loss in an experimental model. Methods:Fifty rats were divided into five groups. In group 0 (control group) only nerve dissection was performed. Total peroneal nerve section was performed in the remaining groups. Immediate end-to-end neurorrhaphy (EEN) was made in group 1. In group 2, an end-to-side neurorrhaphy (ESN) was performed from the tibial nerve to the peroneal nerve. In group 3, a direct EEN, plus an ESN, were used as a nerve graft as a bridge from the donor nerve (tibial); all nerve coaptations were performed through an epineural window. In group 4, only a neurotomy was made without any type of reconstruction. Results:Neural diameters were similar in groups 0, 1, and 3 (38 ± 1 μm, 31 ± 6 μm, 32 ± 3 μm). Neural fibers in group 3 had an 18% increase in the number of axons (P < 0.001) when compared to group 0. Group 2 (28 ± 1 μm) and group 4 (19 ± 3 μm) had diminished diameters with a lower index of muscle regeneration. Animals in group 4 presented with “clawed” lower extremities and had difficulty with ambulation. Neural graft diameters was similar in groups 2 and 3 (33 ± 4 μm, 31 ± 3 μm), but axon density was significantly higher in group 3 (53 ± 6 μm, 39 ± 8 μm) (P < 0.001). Axon density was 36% higher when the combination of EEN and ESN with a neural graft through an epineural window was performed. Conclusion:This study revealed that the combination of EEN and ESN repairs with the addition of a neural graft provides a lower index of muscle fiber destruction, and can be a reliable method for reconstruction in high neural injuries.

     Keywords:Nerve transfer, neurorrhaphy, muscle reinnervation, nerve repair

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