本文選題：自體靜脈神經(jīng)導(dǎo)管　切入點(diǎn)：周圍神經(jīng)再生　出處：《四川大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年05期

【摘要】：目的探索血管支架支撐的自體靜脈神經(jīng)導(dǎo)管對(duì)新西蘭大白兔周圍神經(jīng)缺損再生修復(fù)作用。方法新西蘭大白兔30只,隨機(jī)分為自體神經(jīng)組(A組)、自體靜脈神經(jīng)導(dǎo)管組(B組)、血管支架支撐后的自體靜脈神經(jīng)導(dǎo)管組(C組)3組。分離并切除大白兔左后肢腓總神經(jīng)約10mm,制備腓總神經(jīng)缺損,A組將切除的腓總神經(jīng)旋轉(zhuǎn)180°后縫合于缺損處,B、C組:分離切取20mm長(zhǎng)的頸外靜脈,靜脈回縮修剪后,B組將取下的靜脈橋接于神經(jīng)缺損處,C組將血管支架置入獲取的頸外靜脈,再接于神經(jīng)缺損處。術(shù)后觀察兔足部潰瘍情況,進(jìn)行兔左足展趾反射評(píng)分,術(shù)后12周,進(jìn)行神經(jīng)缺損修復(fù)的大體觀察及電生理檢測(cè),比較各組兔左、右側(cè)后肢腓腸肌濕質(zhì)量比,并對(duì)修復(fù)的神經(jīng)組織進(jìn)行形態(tài)學(xué)觀察和透射電鏡檢測(cè),分析各組神經(jīng)再生及功能恢復(fù)情況。結(jié)果術(shù)后各組均發(fā)現(xiàn)兔手術(shù)側(cè)足跟部潰瘍,以B組最嚴(yán)重,A組最好。術(shù)后12周A組展趾反射評(píng)分恢復(fù)最快且最好,C組次之,B組最差,組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。電生理檢測(cè)A組神經(jīng)傳導(dǎo)速度最快(64.01±5.61)m/s,C組次之(53.43±7.99)m/s,B組最差(29.15±4.45)m/s,各組之間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。腓腸肌濕重比A組C組B組,組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后12周,A組再生神經(jīng)形態(tài)正常,B組靜脈導(dǎo)管坍陷,直徑較小,C組自體血管支架支撐的靜脈導(dǎo)管未塌陷,直徑略大于A組。光鏡及透射電鏡觀察發(fā)現(xiàn)再生神經(jīng)束面積、纖維密集程度及髓鞘厚度均為A組和C組明顯優(yōu)于B組(P0.05)。結(jié)論血管支架支撐自體靜脈神經(jīng)導(dǎo)管能夠較好的促進(jìn)新西蘭大白兔周圍神經(jīng)缺損的再生。
[Abstract]:Objective to explore the effect of autogenous vein nerve catheter supported by vascular stent on regeneration of peripheral nerve defect in New Zealand white rabbits. They were randomly divided into autogenous nerve group (group A), autologous vein nerve conduit group (group B) and group C (group C) after stent support. The common peroneal nerve of left hind limb of rabbits was separated and resected about 10 mm to prepare common peroneal nerve deficiency. In group A, the common peroneal nerve was rotated 180 擄and then sutured to the defect. The external jugular vein of 20mm was removed and removed. After vein retraction and pruning, the vein of group B was bridged to the nerve defect and the vascular stent was placed into the external jugular vein of the nerve defect in group C. after operation, the ulcer of the foot was observed and the reflex score of the left extended toe of the rabbit was evaluated. At 12 weeks after operation, gross observation and electrophysiological examination of nerve defect repair were carried out. The wet mass ratio of gastrocnemius muscle of left and right hind limbs was compared in each group. Morphological observation and transmission electron microscopy were performed on the repaired nerve tissue. Results the nerve regeneration and functional recovery of each group were analyzed. Results all the groups found that the ulcer of the heel was the most serious in group B, the most serious in group A was the best, the score of extended toe reflex was the fastest in group A 12 weeks after operation, and the worst was in group B, which was the best in group C and the worst in group B. There was significant difference between the two groups (P 0.05). Electrophysiological examination showed that the fastest nerve conduction velocity in group A was 64.01 鹵5.61 m / s, followed by group C (53.43 鹵7.99 m / s / s), and the lowest was 29.15 鹵4.45 m / s / s in group B. The wet weight of gastrocnemius muscle in group A was significantly higher than that in group C (P 0.05). At 12 weeks after operation, the regenerated nerves of group A were normal and the venous ducts of group B were collapsing, but the venous ducts supported by autologous vascular stents in group C did not collapse. The diameter of group A was slightly larger than that of group A. the area of regenerated nerve bundle was observed by light microscope and transmission electron microscope. The density of fibers and the thickness of myelin sheath in group A and C were significantly better than those in group B. conclusion Autologous venous nerve catheter supported by vascular stent can promote the regeneration of peripheral nerve defect in New Zealand white rabbits.
【作者單位】： 四川大學(xué)華西醫(yī)院骨科;廣安市人民醫(yī)院骨科;
【基金】：四川省科技廳科技支撐計(jì)劃項(xiàng)目(No.2013FZ0066) 四川省衛(wèi)生和計(jì)生委員會(huì)普及應(yīng)用項(xiàng)目(No.17PJ128) 廣安市2016年創(chuàng)新基金項(xiàng)目資助
【分類號(hào)】：R745

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