周围神经端侧吻合实验研究

目的　探讨神经外膜、束膜开窗神经端侧吻合术在修复周围神经缺损的可行性。方法　将 15只SD大鼠一侧腓总神经切断 ,在胫神经外膜开 1mm小窗 ,将腓总神经远端吻合到胫神经开窗处 ,将腓总神经近端吻合到股外侧肌肉内。对侧肢体作实验对照。术后 3月在全麻下行电生理测试神经冲动传导速度。取端侧吻合口部以远近胫神经、腓总神经及端侧吻合口部神经组织行光镜、电镜观察。结果　发现神经冲动能够通过端侧神经吻合处传播 ,神经传导速度比对照侧神经传导速度慢 ,有明显差异 (P <0 .0 5 )。光镜下吻合口处可见到胫神经发出侧芽。侧芽与胫神经伴行一段距离后 ,分叉离开胫神经 ,进入腓总神经。再生纤维主要为细小的有髓神经纤维。再生神经纤维及髓鞘面积显著小于正常腓总神经。电镜示再生纤维主要为细小的有髓神经纤维。结论　神经端侧吻合后 ,供体神经干可发出侧芽长入受损的神经干 ,侧支再生神经纤维主要为细小的有髓纤维 ,但质量较差。吻合后供体神经不受影响。

Experimental study of nerve regeneration after end-to-side neurorrhaphy

Objective To explore the feasibility of end-to-side neurorrhaphy in repairing nerve injury. Methods A group of 15 SD rats had the peroneal nerve sectioned and the distal endings sutured to the collateral face of tibial nerve after removing a 1 mm epineural window. Results After 3 months, electrophysiological studies showed electrical impulse conducted through the end-to-side junction. The electrical impulse conduction speed was lower than normal(P< 0.05). Histological studies demonstrated that collateral sprouting of tibial nerve was revealed within neurorrhaphy region. The collateral fiber ran along with tibial nerve for certain distance and separated into peroneal nerve in "Y" shape. The regenerating fibers were mainly small myelinated fibers. Electron-microscope showed that the diameter and cross-area of myelin were smaller than those of normal nerve. Conclusion Collateral sprouting of uninjured nerve after end-to-side neurorrhaphy can reinnerve the injured nerve.