摘要
目的:应用小间隙的方法行副神经移位修复C5、臂丛神经上干,以了解副神经移位后的效果及节省动力神经源的可行性。方法:实验于2004-09/12在吉林省外科研究所实验室进行,取40只雄性Wistar大鼠,随机分成两组,每组20只:A组:自体颈静脉桥接行副神经小间隙(2mm)移位于C5神经根,B组:自体颈静脉桥接行副神经小间隙(2mm)吻合于臂丛神经上干,两组均是左侧为正常侧,右侧为实验侧。术中测量副神经、C5神经根和臂丛神经上干的直径;术后12周行电生理学观察两组大鼠肱二头肌、三角肌肌电图波幅和潜伏期;神经组织学和图像观察再生神经纤维数目、轴突直径和髓鞘厚度;透射电镜观察再生神经纤维形态。结果:两组40只大鼠均进入结果分析。①神经直径:副神经主干为(0.45±0.05)mm,C5神经根为(0.66±0.11)mm,臂丛神经上干为(1.16±0.14)mm。②肌电图波幅和潜伏期:术后12周A组肱二头肌、三角肌实验侧和正常侧比较无差异(P>0.05);B组肱二头肌实验侧和正常侧比较无差异,三角肌实验侧较正常侧潜伏期长,波幅低(P<0.05)。③再生神经纤维数目:术后12周A组实验侧和正常侧比较无差异(P>005),B组实验侧明显少于正常侧犤(99.60±22.61),(134.40±30.62)个,t=8.26,P<0.01犦。④轴突直径:术后12周A组实验侧和正常侧比较无差异(P>0.05),B组实验侧明显小于正常侧犤(1.38±0.40),(2.88±0.62)μm,t=19.35,P<0.01犦。⑤髓鞘厚度:术后12周A组实验侧和正常侧无差异(P>005),B组实验侧明显小于正常侧犤(0.92±0.22),(1.75±0.61)μm,t=5.98,P<0.01犦。⑥再生神经纤维形态:A组再生的有髓神经纤维数多,有髓神经纤维髓鞘厚度厚,神经束膜结构完整。B组有髓神经纤维数目明显少,束膜结构不完整,有髓神经纤维鞘可见板层样分离。结论:①应用副神经移位可以修复C5神经根损伤,由于副神经直径相当于C5神经根直径的68%,可以节省动力神经源。②而副神经移位修复臂丛神经上干因两者直径差异明显,副神经只相当于臂丛神经上干直径的39%而不能修复上干。
AIM： To repair nerve root of cervical vertebra 5 （C5） and superior trunk of brachial plexus with the method of small gap, and investigate the effect after accessory nerve transposition and the feasibility of saving power nerve source. METHODS： The experiment was carried out in the laboratory of Jilin Surgery Institute between September and December 2004. Forty male Wistar rats were randomly divided into two groups with 20 rats in each group. In group A： Accessory nerve was transposed to C5 nerve root with small gap （2 mm） autologous jugular vein bridging. In group B： Accessory nerve was transposed to superior trunk of brachial plexus with small gap （2 mm） autologous jugular vein bridging. In both groups, the left side was the normal side, and the right side was the experimental side. The diameters of accessory nerve, C5 nerve root and superior trunk of brachial plexus were measured during the surgery. Twelve weeks after surgery, the amplitude and latency of electromyogram of biceps brachii and triangularis muscle were observed electrophysiologically, the number of regenerated myelinated nerve fiber, axonal diameter and myelinated thickness were analyzed with nerve histology and imaging of nerves, and the form of regenerated nerve fibrers were observed under transmission electron microscope. RESULTS： All the 40 rats in both groups were involved in the analysis of results. ① The diameter was （0.45±0.05） mm for accessory nerve, （0.66±0.11） mm for C5 nerve root and （1.16±0.14） mm for superior trunk of brachial plexus respectively. ② The amplitude and latency of electromyogram： Twelve weeks after surgery, there were insignificant differences between the experimental and normal sides of biceps brachii and triangularis muscle in group A （P 〉 0.05）. In group B, there was insignificant difference between the experimental and normal sides of biceps brachii, and the latency was longer and amplitude was lower in the experimental side than in the normal side of triangularis muscle （P 〈 0.05）. ③ The number of regenerated myelinated nerve fiber： Twelve weeks after surgery, there was no significant difference between the experimental and normal sides in group A （P 〉 0.05）, and obviously fewer in the experimental side than in the normal side in group B [（99.60±22.61）, （134.40±30.62） cells, t=8.26, P 〈 0.01]. ④ Axonal diameter. Twelve weeks after surgery, there was no significant difference between the experimental and normal sides in group A（P 〉 0.05）, and obviously shorter in the experimental side than in the normal side in group B [（1.38±0.40）, （2.88±0.62） μm, t=19.35, P 〈0.01]. ⑤ The myelinated thickness： Twelve weeks after surgery, there was no significant difference between the experimental and normal sides in group A （P 〉 0.05）, and obviously thinner in the experimental side than in the normal side in group B [（0.92±0.22）, （1.75±0.61） μm, t=5.98, P 〈 0.01]. ⑥ The form of regenerated nerve fibrers： In group A, there were more myelinated nerve fiber, thicker myelin, and complete structure of nerve fascicles. In group B, the number of myelinated nerve fiber was obviously fewer, structure of nerve fascicles was incomplete, and layer-like separation could be observed in the myelinated nerve fiber. CONCLUSION： ① Accessory nerve transposition can repair the injury of C5 nerve root, and it can save power nerve source for the diameter of accessory nerve is just 68% to that of C5 nerve root. ② The superior trunk of brachial plexus can not be repaired owing to the significant difference of their diameters, the diameter of accessory nerve is only 39% to that of superior trunk of braehial plexus.
出处
《中国临床康复》
CAS
CSCD
北大核心
2005年第25期37-39,共3页
Chinese Journal of Clinical Rehabilitation
