【摘要】： 周圍神經(jīng)缺損是骨科、顯微外科及戰(zhàn)傷外科治療的一大難題。發(fā)展修復(fù)周圍神經(jīng)系統(tǒng)的技術(shù)已成為醫(yī)學(xué)科學(xué)研究的熱點(diǎn),并已成為生物學(xué)家、生化工程師及材料學(xué)家的重要研究課題。有關(guān)周圍神經(jīng)缺損的研究可追溯到上世紀(jì),自1880年Gluck、Vanlain首先報道用脫鈣骨制成的骨性管道橋接周圍神經(jīng)缺損以來,眾多學(xué)者分別使用動脈、靜脈、筋膜管、硅膠管、膠原管、聚乳酸管及人羊膜、基底膜管和變性骨骼肌等[1,2]橋接周圍神經(jīng)缺損。因為骨骼肌橋本身是生物性自身組織,且具有與周圍神經(jīng)組織相似的纖維狀結(jié)構(gòu)。諸如骨骼肌與周圍神經(jīng)纖維的形狀及都具有外膜、束膜和內(nèi)膜,不存在免疫排斥問題。所以國內(nèi)、外學(xué)者對此進(jìn)行了大量的實驗研究。 目前,在修復(fù)周圍神經(jīng)缺損的研究中,肌橋?qū)υ偕窠?jīng)的誘導(dǎo)作用已無異議。但是,骨骼肌條被橋接后,缺損神經(jīng)的再生的效果頗不一致。筆者認(rèn)為影響神經(jīng)再生的因素很多,其中肌橋構(gòu)型的個性化差異可能是一個重要的原因。為此,為探求更為理想的肌橋本研究對取材于犬的不同部位的肌條內(nèi)肌纖維相對長度和截面積進(jìn)行鏡下觀測及橋接缺損神經(jīng)的實驗觀察。結(jié)果顯示,縫匠肌的肌條內(nèi)肌纖維與肌條長軸平行并且多與肌條等長;指淺屈肌肌纖維走向與肌條長軸夾角較大而且不與肌條等長。不同肌條的肌纖維截面積有很大差異,其中肌纖維走向與肌條長軸夾角較大的肌纖維的截面積也較大。由相對長度較大的肌纖維為主要構(gòu)成的肌橋橋接缺損神經(jīng)的再生效果較好。從而得出,取材于不同骨骼肌的肌橋內(nèi)的肌纖維相對長度和截面積存在個性化的差異。在肌肉橋接神經(jīng)的研究中僅僅將外觀為長條狀的肌肉沿其長軸縱行切取肌橋是不夠的,必須考慮到肌條內(nèi)肌纖維方向與肌條長軸的關(guān)系及其可能產(chǎn)生的影響。即以相對長度較大但截面積較小的肌纖維為主要構(gòu)成的肌橋橋接的缺損神經(jīng)的再生效果較好,因此,縫匠肌肌橋可能是一種較理想的肌橋。
文內(nèi)圖片：
圖片說明：縫匠肌肌橋分離示意圖
[Abstract]:Peripheral nerve defect is a difficult problem in orthopaedics, microsurgery and war injury surgery. The development of techniques for repairing the peripheral nervous system has become a hot topic in medical science, and has become an important research topic for biologists, biochemical engineers and material scientists. The study of peripheral nerve defects can be traced back to the last century. Since 1880 Gluck,Vanlain first reported that bone ducts made of decalcified bone were used to bridge peripheral nerve defects, many scholars used arteries, veins, fascia tubes, silicone tubes, collagen tubes, polylactic acid tubes and human amniotic membrane, basilar canal and denatured skeletal muscle to bridge peripheral nerve defects. Because the skeletal muscle bridge itself is biological self-tissue, and has the fiber-like structure similar to the peripheral nerve tissue. Such as skeletal muscle and peripheral nerve fiber shape and have outer membrane, fasciculus and intima, there is no immune rejection problem. Therefore, domestic and foreign scholars have done a lot of experimental research on this. At present, there is no objection to the induction of regenerated nerve by muscle bridge in the study of repairing peripheral nerve defect. However, after the skeletal muscle strip was bridged, the regeneration effect of defective nerve was quite inconsistent. The author believes that there are many factors affecting nerve regeneration, among which the individualized difference of muscle bridge configuration may be an important reason. Therefore, in order to explore a more ideal muscle bridge study, the relative length and cross section area of muscle fibers in different parts of canine muscle strips were observed under microscope and the defective nerves were bridged. The results showed that the intramuscular fibers of sartorius muscle were parallel to the long axis of muscle strips and were as long as those of muscle strips, and the direction of superficial flexor muscle fibers was larger than that of muscle strips and was not as long as that of muscle strips. The cross section area of muscle fibers of different muscle strips is very different, and the cross section area of muscle fibers with large angle between the direction of muscle fibers and the long axis of muscle strips is also larger. The regeneration effect of muscle bridge defect nerve, which is mainly composed of relatively long muscle fibers, is better. It is concluded that there are individualized differences in the relative length and cross section area of muscle fibers in different skeletal muscle bridges. In the study of muscle bridge nerve, it is not enough to cut the muscle bridge along its long axis, and the relationship between the direction of muscle fiber in muscle strip and the long axis of muscle strip and its possible influence must be taken into account. That is to say, the muscle bridge, which is mainly composed of muscle fibers with large relative length but small cross section area, has better regeneration effect, so the sartorius muscle bridge may be an ideal muscle bridge.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R322

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