摘要
目的 以臂丛神经损伤患者为对象 ,研究不同部位失神经骨骼肌的萎缩规律 ,并探讨细胞凋亡在失神经萎缩骨骼肌中的作用。方法 对 5 0例住院手术的臂丛神经损伤患者 ,术中切取不同部位的失神经骨骼肌 80块 ,按肌肉部位分为A、B两组 ,两组又各分为伤后 1、2、3、4～ 5、6～ 11和 12～ 2 4个月共 6个时间组。A组 :手内在肌 (小指展肌 ) 34块。B组 :大肌肉 (肱二头肌 ) 46块。每块肌肉分别作HE染色、Masson染色和凋亡细胞核的免疫组化染色。结果 (1)随损伤时间的延长 ,肌细胞萎缩愈加明显。各时间组相比 ,A、B组之间差异无显著性意义 (P >0 .0 5 )。(2 )失神经骨骼肌中染成绿色的胶原纤维增多 ,早期增生并不明显 ,失神经支配 1年以上肌肉中的胶原纤维增生更为显著。不同时间组间胶原纤维与骨骼肌细胞面积比的差异 ,有显著性意义 (P <0 .0 5 )。同一时间组内A、B两组肌细胞面积比的差异 ,无显著性意义 (P >0 .0 5 )。 (3)正常的骨骼肌细胞鲜见凋亡细胞核 ,失神经骨骼肌随伤后时间的延长 ,凋亡细胞核数量的增加 ,在小指展肌中的上升速度较肱二头肌快。结论 不同的肌肉在失神经支配后肌萎缩的肌纤维截面积及胶原纤维的增生情况相似 ,胶原纤维的增生只在晚期才成为影响神经修复手术疗效的原因之一。细胞凋亡?
Objective To observe the morphological changes of different muscles after brachial plexus injury and investigate the role of cell apoptosis in denervation atrophy. Methods 50 patients of brachial plexus injuries were involved. 80 denervated muscles were harvested intraoperatively and were divided into two groups: group A (abductor digiti minimi) of 34 samples and group B (biceps brachii) of 46 samples. The denervative intervals of the muscles were 1 month, 2 months, 3 months, 4 ～ 5 months, 6 ～ 11 months, and 12 ～ 24 months respectively. HE staining, Masson staining and immunohistochemical staining of apoptotic nucleus of the muscle samples were carried out. Results (1) There was a sharp decrease in the muscle fiber cross sectional area. There was no significant difference between group A and B. (2) In both group A and B, the longer the denervation time, the more the collagen fibers. The difference between group A and B of same denervation time was not statistically significant. (3) Apoptotic nucleus were rarely seen in normal skeletal muscle. With elongation of denervation time, the number of apoptotic nucleus increased. The number in abductor digiti minimi increased more rapidly than that in biceps brachii. Conclusions The changes of myofiber cross sectional area and collagen fiber content in different muscles were similar. Hyperplasia of collagen fiber only affects the treatment outcome of nerve repair in late stage. Apoptosis is closely related to muscle atrophy. Apoptosis induced decrease of nucleus may be one of the factors influencing treatment outcome in peripheral nerve repair.
出处
《中华手外科杂志》
CSCD
2000年第4期194-197,共4页
Chinese Journal of Hand Surgery
基金
国家973创伤基础研究资助项目!(G1 9990 542 0 2 )
卫生部重点学科基金资助项目!(963)
上海市领先学科基金资助项目!(95 Ⅲ1 )
美
关键词
臂丛损伤
失神经骨骼肌萎缩
细胞凋亡
Brachial plexus
Muscle,Skeletal
Muscular atrophy
Collagen
Apoptosis
