中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (1): 94-99.doi: 10.4103/1673-5374.224376

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

对侧C7神经转移桥接修复损伤正中神经：是否有必要使用整根神经作为供体？

  

  • 收稿日期:2017-10-16 出版日期:2018-01-15 发布日期:2018-01-15
  • 基金资助:

    国家自然科学基金（H0605/81501871）

 Is it necessary to use the entire root as a donor when transferring contralateral C7 nerve to repair median nerve?

Kai-ming Gao1, 2, 3, Jie Lao1, 2, 3, Wen-jie Guan1, 2, 3, Jing-jing Hu4   

  1. 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
    2 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
    3 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
    4 Nursing Department, Huashan Hospital, Fudan University, Shanghai, China
  • Received:2017-10-16 Online:2018-01-15 Published:2018-01-15
  • Contact: Jie Lao, M.D., Ph.D.,laojie633@sina.com.
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. H0605/81501871.

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摘要：

以往文献报道，在修复周围神经损伤时，单纯切取部分健侧C7神经修复一根受体神经常不能得到满意效果，但切取健侧C7全根来修复两个受体神经时，虽然提供给该受体神经的动力仍然为部分健侧C7，但却能获得满意的恢复。这样的结果看似矛盾，但以上两种术式虽然都利用了相同的动力神经，但对健侧C7神经的切取方式不同，真会带来不同的修复效果吗？为验证这一想象的真实性，实验将右侧全臂丛神经损伤大鼠模型随机分3组，全根组切取健侧C7全根作为修复该神经的动力，后股组仅切取健侧C7后股作为动力，全根+后股组同样切取健侧C7全根但仅使用其后股作为动力，3组神经切除后均移位于患侧的正中神经桥接修复。在术后的第8，12，16周，电生理检测见全根组和全根+后股组中正中神经的最大波幅、潜伏期、屈指浅肌的肌张力及肌纤维截面积均显著优于后股组，而全根组和全根+后股组之间差异无显著性意义；正中神经组织中有髓神经纤维计数结果：全根组＞全根+后股组＞后股组。结果证实，修复同一根受体神经时，切取健侧C7神经全根的修复效果显著优于切取部分健侧C7神经，即便切取的C7神经全根中仅有部分被用作修复该神经的动力，此结果说明在进行对侧C7神经转移时应该要使用整根神经作为供体。

orcid:0000-0003-4343-6050(Jie Lao)

关键词: 神经再生, 周围神经损伤, 臂丛神经损伤, 撕脱伤, 健侧颈7神经移位, 神经根, 全根, 部分神经根, 正中神经, 尺神经, 神经再生, 动物实验

Abstract:

If a partial contralateral C7 nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C7  nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C7  nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C7  root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C7  root was transected and transferred to the median nerve. In the entire root + posterior division group, the entire contralateral C7  root was transected but only the posterior division was transferred to the median nerve. After neurectomy,the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root + posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root + posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root + posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C7  root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C7  nerve.

Key words: nerve regeneration, peripheral nerve injury, brachial plexus injury, avulsion injury, contralateral C7 transfer, nerve root, entire root, partial root, median nerve, ulnar nerve, animal experiment, neural regeneration