中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (10): 1703-1707.doi: 10.4103/1673-5374.217350

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

端侧吻合修复周围神经损伤：感觉神经可否诱导运动神经再生？

  

  • 收稿日期:2017-09-17 出版日期:2017-10-15 发布日期:2017-10-15

End-to-side neurorrhaphy repairs peripheral nerve injury: sensory nerve induces motor nerve regeneration

Qing Yu1, She-hong Zhang2, Tao Wang1, Feng Peng1, Dong Han1, Yu-dong Gu1   

  1. 1 Department of Hand Surgery, Huashan Hospital of Fudan University, Key Laboratory of Hand Reconstruction, the Ministry of Health, Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
    2 Department of Rehabilitation Medicine, Huashan Hospital of Fudan University, Shanghai, China
  • Received:2017-09-17 Online:2017-10-15 Published:2017-10-15
  • Contact: Yu-dong Gu,yudonggu@hotmail.com.

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摘要：

端侧神经缝合是长段周围神经缺损修复的替代方式，它是指将断离的周围神经的远侧断端，缝接在附近完整神经干的侧面，但其修复后神经的运动感觉特异性如何目前研究还有争议。为此，我们设计了观察皮神经在端侧缝合后能否诱导运动神经再生，观察损伤围神经端侧缝合后运动感觉特异性的实验研究方案。将30只大鼠随机分为3组：端侧缝合组使用大鼠尺神经作为供体神经和前臂内侧皮神经作为受体神经端侧缝合；假手术组仅暴露尺神经和前臂内侧皮神经；神经切断组切断前臂内侧皮神经并将断端翻转固定。干预5个月后，乙酰胆碱酯酶染色见端侧组缝合组中(34±16)％的有髓神经乙酰胆碱酯酶染色阳性，假手术组及神经切断组未见有髓神经被染色。脊髓运动神经元和背根神经节的Fluoro-Gold标记荧光逆行示踪实验见端侧缝合组前臂内侧皮神经的运动神经元比例为(21±5)％，假手术组及神经切断组在脊髓前角中未出现运动神经元。结果数据提示，皮神经在端侧缝合后能够诱导运动神经的再生。

orcid:0000-0003-3143-8307(Yu-dong Gu)

关键词: 神经再生, 周围神经损伤, 端侧神经缝合, 运动感觉特异性, 大鼠, 背根神经节, 运动神经元, 轴突, 前臂内侧皮神经, 尺神经, 乙酰胆碱酯酶染色, 逆行神经元追踪

Abstract:

End-to-side neurorrhaphy is an option in the treatment of the long segment defects of a nerve. It involves suturing the distal stump of the disconnected nerve (recipient nerve) to the side of the intimate adjacent nerve (donor nerve). However, the motor-sensory specificity after end-to-side neurorrhaphy remains unclear. This study sought to evaluate whether cutaneous sensory nerve regeneration induces motor nerves after end-to-side neurorrhaphy. Thirty rats were randomized into three groups: (1) end-to-side neurorrhaphy using the ulnar nerve (mixed sensory and motor) as the donor nerve and the cutaneous antebrachii medialis nerve as the recipient nerve; (2) the sham group: ulnar nerve and cutaneous antebrachii medialis nerve were just exposed; and (3) the transected nerve group: cutaneous antebrachii medialis nerve was transected and the stumps were turned over and tied. At 5 months, acetylcholinesterase staining results showed that 34% ± 16% of the myelinated axons were stained in the end-to-side group, and none of the myelinated axons were stained in either the sham or transected nerve groups. Retrograde fluorescent tracing of spinal motor neurons and dorsal root ganglion showed the proportion of motor neurons from the cutaneous antebrachii medialis nerve of the end-to-side group was 21% ± 5%. In contrast, no motor neurons from the cutaneous antebrachii medialis nerve of the sham group and transected nerve group were found in the spinal cord segment. These results confirmed that motor neuron regeneration occurred after cutaneous nerve end-to-side neurorrhaphy.

Key words: nerve regeneration, peripheral nerve injury, end-to-side neurorrhaphy, motor-sensory specificity, rat, dorsal root ganglion, motor neuron, axon, cutaneous antebrachii medialis nerve, ulnar nerve, acetylcholinesterase staining, retrograde neuron tracing, neural regeneration