摘要
目的:观察生物膜防止神经粘连的作用并与静脉、己丁糖、强的松龙以及单纯缝合进行对比,探索促进神经再生的方法。方法:实验于2002-04/07在解放军总医院骨科实验室完成。将新西兰大白兔随机分为5组:生物膜组、己丁糖组、强的松龙组、静脉组及单纯缝合组,每组12只。①模型制作:采用250g/L乌拉坦静脉麻醉,显露兔的双侧坐骨神经,并在胫骨外髁上方1cm处切断胫神经,双侧作同样处理。在手术显微镜下,将胫神经端端吻合,并将吻合口周围肌肉作适当损伤以形成瘢痕。②分组处理:生物膜组:生物膜片包裹神经吻合口,并将两端缝合成管状,生物膜管两端各与神经外膜固定1针。己丁糖组:在吻合口周围涂抹0.5mL己丁糖。强的松龙组:在吻合口周围注射0.5mL强的松龙。静脉组:取一段兔颈外静脉,长约2cm,分为两段,分别套在双侧胫神经上,两端各固定1针。单纯缝合组:直接吻合后放入肌间隙,吻合口不作特殊处理。③指标测试:于术后2,4,10和16周用肉眼观察足底溃疡及愈合情况,神经吻合口的粘连程度;取各时间段神经吻合口上下5mm神经,光镜观察再生神经通过吻合口情况及结缔组织增生情况;取吻合口近远端各2mm长神经,用伪彩色图像分析行轴突数目分析;对16周组,用诱发电位仪检测其神经传导速度、诱发电位波幅及潜伏期;在透射电镜下观察其超微结构特征。结果:每组12只新西兰白兔均纳入结果分析。①大体观察:单纯缝合组修复段神经2周时为瘢痕组织包裹压迫固定,4和10周时粘连加重,神经无活动度。静脉包裹组修复段神经2周时与周围界限清楚,4,10和16周时与周围粘连固定,无活动度。生物膜组、己丁糖组及强的松龙组各时间段神经活动不受限。②组织学检查:生物膜组、己丁糖组和强的松龙组再生纤维通过吻合口较直,神经内无明显结缔组织增生。单纯缝合组神经
AIM： To investigate the effect of biofilm in preventing scar adhesion after nerve injury, and compare the above effects with effects of vein, chitosan, prednisolone and simple anastomosis so as to probe into a new method to improve nerve regeneration. METHODS： The experiment was fulfilled in Department of Orthopaedics, General Hospital of Chinese PLA from April to July 2002. Sixty New Zealand big white rabbits were randomized into biofilm, chitosan, prednisolone, vein and simple anastomosis groups with 12 rabbits in each group. ①Modeling： The rabbits were anesthetized by 250 g/L urethane to expose the bilateral sciatic nerves; The tibial nerve was cut 1cm above lateral tibial condyle. The operation was same in both sides. The tibial nerve was anastomosed end-to-end under a surgical microscope, and the muscle around the anastomosed site was injured properly to induce scar. ②Treatment according to grouping： For the biofilm group, the anastomosis site was embedded by the biofilm and was sutured to a conduit, and thenboth sides were fixed to the epineurium by a needle. For the chitisan group, chitosan 0.5 mL was daubed around the anastomosed site. For the prednisolone group, prednisolone 0.5 mL was injected into the anastomosed site. For the vein group, rabbit external jugular vein about 2 cm was divided into 2 pieces. Each vein was knotted to one side tibial nerve and fixed by a needle. For the simple anastomosis group, the anastomosed site was not treated. ③Test of indexes： Plantar ulcer, healing and nerve adhesion degree were observed by naked eyes at 2, 4, 10, 16 weeks after operation. Nerve 5 mm of the upper and lower anastomosed site was obtained. The regenerative nerve fiber through the anastomoscd site and connective tissue hyperplasia were observed by light microscopy. Nerve 2 mm in length of the distal and proximal anastomosed site was analyzed by counting axons using the pseudo-color image analyzing system. Nerve conduction velocity （NCV）, evoked potential amplitude and incubation perio
出处
《中国临床康复》
CSCD
北大核心
2005年第34期58-60,i0004,共4页
Chinese Journal of Clinical Rehabilitation
