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 (11): 1968-1973.doi: 10.4103/1673-5374.239444

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

全臂丛神经损伤：改良健侧颈7神经根移位修复下干与传统健侧颈7移位术式修复的效果比较

  

  • 收稿日期:2018-07-11 出版日期:2018-11-15 发布日期:2018-11-15
  • 基金资助:

    中国国家自然科学基金项目（81572127）

Total brachial plexus injury: contralateral C7 root transfer to the lower trunk versus the median nerve

Ye Jiang1, 2, 3, Li Wang4, Jie Lao1, 2, 3, Xin Zhao1, 2, 3   

  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 Department of Hand Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
  • Received:2018-07-11 Online:2018-11-15 Published:2018-11-15
  • Contact: Jie Lao, MD,xlcrystal87@hotmail.com
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. 81572127.

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摘要：

健侧C7神经根移位是治疗全臂丛神经根性损伤的主要方法，通过改良健侧颈7神经根移位修复下干是该方法的一种较新的改良，目前的研究已通过电生理和组织学检测显示其客观的有效性。为验证此结论，实验设计建立截断左侧臂丛神经根建立全臂丛神经根性损伤模型大鼠，分别以改良的椎体前路健侧C7神经根移位修复下干和传统的健侧C7分2期通过尺神经桥接移位修复正中神经进行修复治疗。分别在损伤后4，8，12周时，以抓握试验测试大鼠前爪握力变化，以电生理仪和多通道生理信号采集系统记录指浅屈肌的电生理学变化，以电子天平检测前臂屈肌湿重变化，以苏木精-伊红染色检测指浅屈肌肌萎缩情况，以甲苯胺蓝染色检测损伤神经中有髓神经纤维数量的变化。与传统方法相比，改良健侧颈7神经根移位修复下干方法治疗全臂丛神经损伤模型大鼠前爪抓握力明显增加，指浅屈肌复合肌肉动作电位最大振幅增加，潜伏期缩短，前臂屈肌收缩力明显恢复，屈肌肌肉湿重增加，指浅屈肌萎缩减少，损伤神经中有髓神经纤维数量增加。数据显示，对于全臂丛神经损伤模型大鼠，改良的椎体前路健侧颈7神经根移位修复下干比传统健侧颈7分二期通过尺神经桥接移位修复正中神经更为有效。

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

关键词: 全臂丛神经损伤, 健侧C7神经根, 神经移位, 下干, 正中神经, 神经再生

Abstract:

Contralateral C7 (cC7) root transfer to the healthy side is the main method for the treatment of brachial plexus root injury. A relatively new modification of this method involves cC7 root transfer to the lower trunk via the prespinal route. In the current study, we examined the effectiveness of this method using electrophysiological and histological analyses. To this end, we used a rat model of total brachial plexus injury, and cC7 root transfer was performed to either the lower trunk via the prespinal route or the median nerve via a subcutaneous tunnel to repair the injury. At 4, 8 and 12 weeks, the grasping test was used to measure the changes in grasp strength of the injured forepaw. Electrophysiological changes were examined in the flexor digitorum superficialis muscle. The change in the wet weight of the forearm flexor was also measured. Atrophy of the flexor digitorum superficialis muscle was assessed by hematoxylin-eosin staining. Toluidine blue staining was used to count the number of myelinated nerve fibers in the injured nerves. Compared with the traditional method, cC7 root transfer to the lower trunk via the prespinal route increased grasp strength of the injured forepaw, increased the compound muscle action potential maximum amplitude, shortened latency, substantially restored tetanic contraction of the forearm flexor muscles, increased the wet weight of the muscle, reduced atrophy of the flexor digitorum superficialis muscle, and increased the number of myelinated nerve fibers. These findings demonstrate that for finger flexion functional recovery in rats with total brachial plexus injury, transfer of the cC7 root to the lower trunk via the prespinal route is more effective than transfer to the median nerve via subcutaneous tunnel.

Key words: nerve regeneration, total brachial plexus injury, contralateral C7 root, nerve transfer, lower trunk, median nerve, neural regeneration