中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (4): 699-705.doi: 10.4103/1673-5374.247474

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

不同神经转位修复正中神经后脊髓前角细胞功能的再支配

  

  • 出版日期:2019-04-15 发布日期:2019-04-15
  • 基金资助:

    国家自然科学基金（31571236，31571235）; 中国国家重点研究发展计划（2016YFC1101604）; 中国国家重点基础研究计划（973计划）（2014CB542200）; 中国教育部创新计划编号IRT_16R01; 北京科技新星跨国项目（2018019）; 北京大学人民医院研究与发展基金（RDH2017-01）

Reinnervation of spinal cord anterior horn cells after median nerve repair using transposition with other nerves

Yu-Song Yuan 1 , Su-Ping Niu 1 , You-Lai Yu 2 , Pei-Xun Zhang 1 , Xiao-Feng Yin 1 , Na Han 1 , Ya-Jun Zhang 1 , Dian-Ying Zhang 1 , Hai-Lin Xu 1 , Yu-Hui Kou 1 , Bao-Guo Jiang 1   

  1. 1 Peking University People’s Hospital, Beijing, China
    2 The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
  • Online:2019-04-15 Published:2019-04-15
  • Contact: Yu-Hui Kou, MD, PhD, yuhuikou@bjmu.edu.cn; Bao-Guo Jiang, MD, PhD, jiangbaoguo@vip.sina.com.
  • Supported by:

    This research was continuously funded by the National Natural Science Foundation of China, No. 31571236, 31571235 (to YHK, PXZ); the National Key Research and Development Program of China, No. 2016YFC1101604 (to DYZ); the National Key Basic Research Program of China (973 Program), No. 2014CB542200 (to BGJ); the Ministry of Education Innovation Program of China, No. IRT_16R01 (to BGJ); the Beijing Science and Technology New Star Cross Program of China, No. 2018019 (to PXZ); the Peking University People’s Hospital Research and Development Funds, No. RDH2017-01 (to HLX)

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摘要：

作者在前期研究已证实在神经转位修复周围神经损伤过程中，脊髓前角运动神经元再生的神经纤维能够有效转位修复远端神经及靶肌肉组织，恢复肌肉运动功能。由此，为对比观察几种神经转位修复正中神经缺损（2mm）后的神经再生及运动功能恢复效果，实验将30只SD大鼠随机分为假手术组、正中神经外膜原位缝合组、肌皮神经转位修复正中神经组、胸内侧神经转位修复正中神经组、桡神经肌支转位修复正中神经组。神经修复后3个月，以屈腕试验评估大鼠患肢正中神经再生后屈腕功能恢复情况；应用锇酸染色检测修复段神经近、远端有髓神经纤维数量及髓鞘厚度、轴突直径、轴突横截面积；计算新生的远端有髓神经纤维数量和近端有髓神经纤维数量的比值；称量指浅屈肌湿重，并以HE染色方法检测肌纤维形态，计算肌纤维横截面积，以评估肌肉恢复情况。结果发现，神经转位修复的3组和神经原位外膜缝合组的大鼠屈腕功能明显恢复，均有神经长入远端效应器，每组新生的有髓神经纤维数量差异明显，且存在不同程度的倍数再生现象，原位缝合、肌皮神经转位修复、胸内侧神经转位修复、桡神经肌支转位修复四组的放大倍率分别为1.80、3.00、2.50、3.12。但是不同前角运动神经元来源的3组供体神经转位修复后的新生神经纤维的轴突直径、轴突横截面积、髓鞘厚度、指浅屈肌湿重及其肌纤维横截面积与神经外膜原位缝合组相近。结果表明，来源于不同的前角运动神经元的供体神经转位可有效修复原正中神经支配的靶器官，相应神经的脊髓前角运动神经元能够实现功能的再支配，一定程度上保留患肢的运动功能。

orcid: 0000-0001-8436-5266(Bao-Guo Jiang)

关键词: 转位修复, 正中神经, 功能重塑, 肌肉萎缩, 外科干预, 周围神经损伤, 神经再生

Abstract:

Our previous studies have confirmed that during nerve transposition repair to injured peripheral nerves, the regenerated nerve fibers of motor neurons in the anterior horn of the spinal cord can effectively repair distal nerve and target muscle tissue and restore muscle motor function. To observe the effect of nerve regeneration and motor function recovery after several types of nerve transposition for median nerve defect (2 mm), 30 Sprague-Dawley rats were randomly divided into sham operation group, epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group. Three months after nerve repair, the wrist flexion test was used to evaluate the recovery of wrist flexion after regeneration of median nerve in the affected limbs of rats. The number of myelinated nerve fibers, the thickness of myelin sheath, the diameter of axons and the cross-sectional area of axons in the proximal and distal segments of the repaired nerves were measured by osmic acid staining. The ratio of newly produced distal myelinated nerve fibers to the number of proximal myelinated nerve fibers was calculated. Wet weights of the flexor digitorum superficialis muscles were measured. Muscle fiber morphology was detected using hematoxylin-eosin staining. The cross-sectional area of muscle fibers was calculated to assess the recovery of muscles. Results showed that wrist flexion function was restored, and the nerve grew into the distal effector in all three nerve transposition groups and the epineurial neurorrhaphy group. There were differences in the number of myelinated nerve fibers in each group. The magnification of proximal to distal nerves was 1.80, 3.00, 2.50, and 3.12 in epineurial neurorrhaphy group, musculocutaneous nerve transposition group, medial pectoral nerve transposition group, and radial nerve muscular branch transposition group, respectively. Nevertheless, axon diameters of new nerve fibers, cross-sectional areas of axons, thicknesses of myelin sheath, wet weights of flexor digitorum superficialis muscle and cross-sectional areas of muscle fibers of all three groups of donor nerves from different anterior horn motor neurons after nerve transposition were similar to those in the epineurial neurorrhaphy group. Our findings indicate that donor nerve translocation from different anterior horn motor neurons can effectively repair the target organs innervated by the median nerve. The corresponding spinal anterior horn motor neurons obtain functional reinnervation and achieve some degree of motor function in the affected limbs.

Key words: nerve regeneration, transposition repair, median nerve, functional remodeling, muscle atrophy, surgical intervention, peripheral nerve injury, neural regeneration