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 (12): 2077-2083.doi: 10.4103/1673-5374.221167

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

较少纤维数量的自体移植神经能够满足粗大周围神经缺损的修复？

  

  • 收稿日期:2017-11-25 出版日期:2017-12-15 发布日期:2017-12-15
  • 基金资助:

    中国国家重点基础研究项目（973计划）（2014cb542200）；教育部创新团队（irt1201）；国家自然科学基金（31271284, 31171150, 8117114630971526，31100860, 31040043, 31640045，31671246）；教育部新世纪优秀人才支持计划（bmu20110270）；中国国家重点研究发展计划(2016yfc1101604)

Autologous transplantation with fewer fibers repairs large peripheral nerve defects

Jiu-xu Deng, Dian-yin Zhang, Ming Li, Jian Weng, Yu-hui Kou, Pei-xun Zhang, Na Han, Bo Chen, Xiao-feng Yin, Bao-guo Jiang   

  1. Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing, China
  • Received:2017-11-25 Online:2017-12-15 Published:2017-12-15
  • Contact: Xiao-feng Yin, M.D. or Bao-guo Jiang, M.D.,xiaofengyin@bjmu.edu.cn or jiangbaoguo@vip.sina.com.
  • Supported by:

    This study was supported by the National Basic Research Program of China (973 Program), No. 2014CB542200; a grant from the Ministry of Education Innovation Team, No. IRT1201; the National Natural Science Foundation of China, No. 31271284, 31171150, 81171146,30971526, 31100860, 31040043, 31640045, 31671246; a grant from the Educational Ministry New Century Excellent Talents Support Project in China, No. BMU20110270; a grant from the National Key Research and Development Program in China, No. 2016YFC1101604.

PDF

321

摘要：

周围神经修复过程中存在神经纤维数量的再生放大效应，远端再生的神经纤维数量显著大于近端的神经纤维。目前临床上常利用自体细小的感觉神经通过电缆式缝合来修复缺损的运动神经，但移植段神经纤维与缺损神经纤维数量的比例关系尚不清楚，究竟需要多少数量的神经纤维才能达到较好的修复效果呢？实验将大鼠右侧腓总神经切除10 mm，建立腓总神经缺损模型，损伤后即利用切除的腓总神经原位缝合作为原位缝合组；切取10-30 mm长的同侧腓肠神经，移植段每束腓肠神经长10 mm，利用电缆式缝合方法设为单束、双束、三束腓肠神经移植组，为了减少由于周围侵入组织和神经残端之间的结缔组织过度生长而产生的屏障效应，在近端和远端两端使用小间隙套管缝合，以此修复缺损的腓总神经。神经缺损修复术后3个月利用锇酸染色和功能学检测的方法观察腓总神经远端再生神经的形态学和功能的修复效果发现，单束腓肠神经移植组、双束腓肠神经移植组、3束腓肠神经移植组远端腓总神经再生纤维的数量、腓总神经功能指数、运动神经传导速度、胫骨前肌肌力恢复和肌肉湿量均差异无显著性意义。上述结果说明，神经纤维数量较少的单束腓肠神经移植能够同样达到双束腓肠神经移植组和3束腓肠神经移植组同样的修复效果。实验通过周围神经再生放大效应，利用较少纤维数量的移植神经能够满足粗大神经缺损修复的需要。

orcid:0000-0003-2670-3153(Jiu-xu Deng)
0000-0001-9932-642X(Xiao-feng Yin)
0000-0001-8436-5266(Bao-guo Jiang)

关键词: 神经再生, 周围神经, 周围神经损伤, 周围神经缺损, 自体神经移植, 功能恢复, 神经再生, 神经传导速度, 腓肠神经, 腓总神经, 套接缝合

Abstract:

Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of transplanted nerve attains maximum therapeutic effect remains poorly understood. In this study, a rat model of common peroneal nerve defect was established by resecting a 10-mm long right common peroneal nerve. Rats receiving transplantation of the common peroneal nerve in situ were designated as the in situ graft group. Ipsilateral sural nerves (10–30 mm long) were resected to establish the one sural nerve graft group, two sural nerves cable-style nerve graft group and three sural nerves cable-style nerve graft group. Each bundle of the peroneal nerve was 10 mm long. To reduce the barrier effect due to invasion by surrounding tissue and connective-tissue overgrowth between neural stumps, small gap sleeve suture was used in both proximal and distal terminals to allow repair of the injured common peroneal nerve. At three months postoperatively, recovery of nerve function and morphology was observed using osmium tetroxide staining and functional detection. The results showed that the number of regenerated nerve fibers, common peroneal nerve function index, motor nerve conduction velocity, recovery of myodynamia, and wet weight ratios of tibialis anterior muscle were not significantly different among the one sural nerve graft group, two sural nerves cable-style nerve graft group, and three sural nerves cable-style nerve graft group. These data suggest that the repair effect achieved using one sural nerve graft with a lower number of nerve fibers is the same as that achieved using the two sural nerves cable-style nerve graft and three sural nerves cable-style nerve graft. This indicates that according to the ‘multiple amplification’ phenomenon, one small nerve graft can provide a good therapeutic effect for a large peripheral nerve defect.

Key words: nerve regeneration, peripheral nerve injury, peripheral nerve defect, autologous nerve graft, functional recovery, nerve conduction velocity, sural nerve, common peroneal nerve, sleeve bridging suture, neural regeneration