發(fā)布時(shí)間：2018-03-24 22:15

  本文選題：面神經(jīng)損傷　切入點(diǎn)：吻合術(shù)　出處：《天津醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:本研究擬通過預(yù)變性的舌下神經(jīng)行舌下-面神經(jīng)端端吻合術(shù)修復(fù)完全性損傷的面神經(jīng),同時(shí)通過面容對稱性評估面癱程度、神經(jīng)電生理檢測面肌動(dòng)作電位、組織學(xué)方法檢測神經(jīng)髓鞘形態(tài),比較面神經(jīng)損傷后不同時(shí)期舌下-面神經(jīng)吻合術(shù)的治療效果,旨在為面神經(jīng)損傷修復(fù)選擇一個(gè)最佳的時(shí)機(jī)。方法:56只大鼠隨機(jī)分成8組,健康對照組,即時(shí)修復(fù)組,延遲1周修復(fù)組,延遲2周修復(fù)組,延遲3周修復(fù)組,延遲1月修復(fù)組,延遲3月修復(fù)組,完全面癱組。同時(shí),實(shí)驗(yàn)組大鼠面神經(jīng)修復(fù)前1周分別制備預(yù)變性的自體舌下神經(jīng)移植物,將預(yù)變性7天的舌下神經(jīng)近端與面神經(jīng)遠(yuǎn)端行端端吻合。通過面神經(jīng)損傷后1周、修復(fù)術(shù)后3個(gè)月行鼻尖偏離指數(shù)的測量來評價(jià)面癱的分級;面神經(jīng)修復(fù)術(shù)后3個(gè)月進(jìn)行神經(jīng)電生理檢測面肌動(dòng)作電位的潛伏期和振幅;修復(fù)術(shù)后3個(gè)月電鏡切片觀察髓鞘再生形態(tài)及數(shù)量。結(jié)果:1、即時(shí)修復(fù)組與延遲1周修復(fù)組鼻尖偏離指數(shù)檢測а角度優(yōu)于其他各延遲吻合組(P0.05),這兩組間差異無統(tǒng)計(jì)學(xué)意義(P=0.705)。延遲3月修復(fù)組鼻尖偏離指數(shù)檢測а角明顯小于其他各組延遲,延遲3周吻合組、延遲1月吻合組與延遲3月修復(fù)組之間a角差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2、面肌動(dòng)作電位檢測結(jié)果顯示即時(shí)修復(fù)組與延遲1周修復(fù)組的誘發(fā)性胡須墊肌肌電圖的潛伏期短于其它各延遲修復(fù)組,這兩組間差異無統(tǒng)計(jì)學(xué)意義(P=0.385)。延遲1周修復(fù)組的振幅大于即時(shí)修復(fù)組和其它各延遲修復(fù)組(P0.05);同時(shí),延遲1月修復(fù)組與延遲3月修復(fù)組的振幅比其它各延遲修復(fù)組低,潛伏期比其他修復(fù)組延長。這說明從神經(jīng)電生理指標(biāo)看,延遲1周修復(fù)組神經(jīng)再生效果不差于即時(shí)修復(fù)組。而當(dāng)面神經(jīng)延遲1月-3月吻合時(shí),神經(jīng)再生效果明顯變差。3、計(jì)算各組面神經(jīng)吻合口遠(yuǎn)端有髓纖維髓鞘數(shù)量,電鏡觀察面神經(jīng)損傷遠(yuǎn)端神經(jīng)再生有髓纖維髓鞘形態(tài)和數(shù)量,計(jì)算機(jī)圖象分析系統(tǒng)計(jì)算神經(jīng)髓鞘腔面積和髓鞘厚度。結(jié)果顯示即時(shí)修復(fù)組和延遲1周修復(fù)組的神經(jīng)有髓纖維髓鞘數(shù)量明顯高于其它各延遲修復(fù)組(P0.05),這兩組間差異無統(tǒng)計(jì)學(xué)意義(P=0.108);延遲1月組和延遲3月組的神經(jīng)有髓纖維髓鞘數(shù)量低于其它各延遲修復(fù)組(P0.05),此二組間差異無統(tǒng)計(jì)學(xué)意義(P=0.181);電鏡觀察髓鞘形態(tài),即時(shí)修復(fù)組與延遲1周修復(fù)組的神經(jīng)髓鞘形態(tài)與正常組相似,表現(xiàn)為髓鞘形狀為較規(guī)則的橢圓形,有髓纖維較粗,髓鞘板層結(jié)構(gòu)致密,軸突的軸膜完整;即時(shí)修復(fù)組的髓鞘腔面積比延遲1周修復(fù)組和其它延遲修復(fù)組大,但即時(shí)修復(fù)組和延遲1周修復(fù)組相比差異無統(tǒng)計(jì)學(xué)意義(P=0.068);即時(shí)修復(fù)組、延遲1周修復(fù)組面神經(jīng)再生有髓纖維髓鞘厚度與正常組無統(tǒng)計(jì)學(xué)差異,這兩組間比較差異亦無統(tǒng)計(jì)學(xué)意義(P=0.057),但延遲1周修復(fù)組的髓鞘厚度稍大于即時(shí)修復(fù)組。此結(jié)果說明從面神經(jīng)再生有髓纖維各指標(biāo)看,延遲1周修復(fù)面神經(jīng)的效果不比即時(shí)修復(fù)差。結(jié)論:以上研究表明,面神經(jīng)損傷后,用面容對稱性、神經(jīng)電生理、再生神經(jīng)有髓纖維形態(tài)等一系列指標(biāo)綜合評價(jià)面神經(jīng)的再生情況,延遲1周修復(fù)有著不差于即時(shí)修復(fù)神經(jīng)再生的效果。而延遲1月、3月修復(fù)組神經(jīng)再生的效果比其它各延遲修復(fù)組差。臨床可以此為參考,在即時(shí)吻合不允許的情況下,可適當(dāng)延遲一段時(shí)間行面神經(jīng)修復(fù)術(shù),同時(shí),盡量在面神經(jīng)損傷后3個(gè)月內(nèi)修復(fù)。
[Abstract]:Objective: This study through the pre degeneration of the hypoglossal nerve for hypoglossal facial nerve anastomosis to repair complete injury of facial nerve, and through face symmetry evaluation of facial palsy degree, electrophysiological examination of facial action potentials, histological detection of myelin formation, therapeutic effect of facial nerve anastomosis between different period after hypoglossal nerve injury, facial nerve injury repair to choose a best time. Methods: 56 rats were randomly divided into 8 groups, control group, immediate repair group, 1 week delay repair group, 2 week delay repair group, 3 week delay repair group, delayed repair group in January March, delay repair group, complete paralysis group. At the same time, the facial nerve of experimental rats repaired 1 weeks before were prepared under the autologous lingual predegenerated nerve graft, pre degeneration 7 days of hypoglossal nerve proximal and distal facial nerve anastomoses. The facial nerve injury After 1 weeks, measured 3 months after repair of nasal tip deviation index to evaluate the classification of facial paralysis; electrophysiological detection of facial action potential latency and amplitude of 3 months after the repair of facial nerve; observe the remyelination of morphology and number of 3 months after the repair of electron microscope. Results: 1, immediate repair group and 1 week delay repair group nasal deviation index than other delay angle detection. The anastomosis group (P0.05), there was no significant difference between the two groups (P=0.705). In March delayed repair group nasal deviation index was significantly less than the other groups. The detection angle of delay, delayed 3 weeks delayed anastomosis group, anastomosis group and delayed in January between March a angle repair group showed no significant difference (P0.05.2), facial action potential detection results show that the latency of immediate repair group and delayed 1 weeks to repair groups induced by whisker pads electromyography shorter than other delayed repair group, between the two groups There was no statistically significant difference (P=0.385). 1 weeks of repair delay amplitude were greater than those of immediate repair group and other delayed repair group (P0.05); at the same time, delay and amplitude of group delay in March January to repair repair group than other groups of low latency delayed repair, other than repair group. This shows that extended from neural electrophysiological index look, the 1 week delay repair group, the effect of nerve regeneration is not worse than the immediate repair group. In January -3 month delay neural anastomosis, the effect of nerve regeneration was significantly worse.3, calculate the facial nerve anastomosis of distal number of myelinated fiber myelin, electron microscope observation of facial nerve injury of the distal nerve regeneration of myelinated fiber morphology and number of myelin. The calculation of myelin sheath thickness and cavity area of computer image analysis system. Results show that the instant repair group and delayed 1 weeks the number of myelinated nerve repair group was significantly higher than that of other delayed myelin repair group (P0.05), 榪欎袱緇勯棿宸紓鏃犵粺璁″鎰忎箟(P=0.108);寤惰繜1鏈堢粍鍜屽歡榪，

本文編號：1660245