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 (4): 699-703.doi: 10.4103/1673-5374.230296

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

粗大供体神经和细小受体神经之间的端-端和端-侧神经吻合修复：大鼠模型中的轴突再生

  

  • 收稿日期:2018-01-31 出版日期:2018-04-15 发布日期:2018-04-15

End-to-end and end-to-side neurorrhaphy between thick donor nerves and thin recipient nerves: an axon regeneration study in a rat model

Tohru Tateshita1, Kazuki Ueda2, Akiyoshi Kajikawa1   

  1. 1 Department of Plastic and Reconstructive Surgery, St. Marianna Medical University, Kawasaki City, Japan
    2 Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima Perfecture, Japan
  • Received:2018-01-31 Online:2018-04-15 Published:2018-04-15
  • Contact: Tohru Tateshita, M.D.,rukko296@yahoo.co.jp

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摘要：

在神经重建术中，经常会出现将不同直径的神经进行端-端或端-侧神经吻合修复的情况，为观察端-端或端-侧神经吻合修复后的轴突再生，实验切断面神经下颌支，以其主干残端与分叉后的分支残端（两者直径比为2：1）进行端-端或端-侧神经吻合。端-端神经吻合修复后6周再生有髓鞘轴突数量和再生率明显大于端-侧神经吻合修复；然而，在12周时未观察到这种差异。虽然12周时再生的轴突比6周时更粗，但在端-端和端-侧神经吻合修复之间没有检测到轴突纤维厚度的明显差异。因此，端-端神经吻合修复早期再生轴突数量、厚度和再生率均优于端-侧神经吻合修复。由于快速神经支配是影响目标肌肉功能恢复的最重要因素之一，因此我们认为当将粗神经和细神经进行神经缝合修复时，端对端神经吻合更为合适。

orcid:0000-0002-6280-777X(Tohru Tateshita)
        0000-0002-8242-3802(Akiyoshi Kajikawa)

关键词: 神经外膜窗, 移植, 神经重建, 缝合, 面神经, 神经外科, 轴突, 神经修复, 周围神经, 神经再生

Abstract:

During nerve reconstruction, nerves of different thicknesses are often sutured together using end-to-side neurorrhaphy and end-to-end neurorrhaphy techniques. In this study, the effect of the type of neurorrhaphy on the number and diameter of regenerated axon fibers was studied in a rat facial nerve repair model. An inflow-type end-to-side and end-to-end neurorrhaphy model with nerve stumps of different thicknesses (2:1 diameter ratio) was created in the facial nerve of 14 adult male Sprague-Dawley rats. After 6 and 12 weeks, nerve regeneration was evaluated in the rats using the following outcomes: total number of myelinated axons, average minor axis diameter of the myelinated axons in the central and peripheral sections, and axon regeneration rate. End-to-end neurorrhaphy resulted in a significantly greater number of regenerated myelinated axons and rate of regeneration after 6 weeks than end-to-side neurorrhaphy; however, no such differences were observed at 12 weeks. While the regenerated axons were thicker at 12 weeks than at 6 weeks, no significant differences in axon fiber thickness were detected between end-to-end and end-toside neurorrhaphy. Thus, end-to-end neurorrhaphy resulted in greater numbers of regenerated axons and increased axon regeneration rate during the early postoperative period. As rapid reinnervation is one of the most important factors influencing the restoration of target muscle function, we conclude that end-to-end neurorrhaphy is desirable when suturing thick nerves to thin nerves.

Key words: epineural window, transplantation, nerve reconstruction, suturing, facial nerve repair, axonal repair, neurosurgery, peripheral nerve, neural regeneration