Scherman P, Lundborg G, Kanje M, Dahlin L B
Department of Hand Surgery, Malmö University Hospital, Sweden.
J Neurosurg. 2001 Aug;95(2):316-23. doi: 10.3171/jns.2001.95.2.0316.
The authors have previously shown that longitudinal sutures without artificial tube support regeneration across a 7-mm gap in the rat sciatic nerve. In the present study, the authors compared this new approach with the use of autologous nerve grafts across short defects and examined whether the approach could be used to support regeneration across extended gaps and whether the interposition of a short nerve segment (the stepping-stone procedure) was applicable in this model.
Longitudinal sutures were used to bridge 7- and 15-mm gaps in the rat sciatic nerve. Contralateral comparisons were made to nerve autografts in the 7-mm group and to sutures plus a short interposed nerve segment in the 15-mm group. Regeneration was evaluated at 2, 4, and 12 weeks by using immunocytochemical analysis for Schwann cells, neurofilament protein, and macrophages and at 12 weeks also by using histological examination, including morphometry in the distal tibial trunk and tetanic force measurements in the gastrocnemius muscle.
The authors found that the results of regeneration after repair with longitudinal polyglactin sutures across short defects were not significantly different from those produced by the use of autologous nerve grafts. Regeneration, although poor, occurred along sutures across extended gaps and was significantly enhanced by an interposed nerve segment acting as a Schwann cell resource in this model.
作者之前已经表明，在大鼠坐骨神经中，纵向缝合在没有人工导管支撑的情况下可使神经在7毫米间隙上再生。在本研究中，作者将这种新方法与自体神经移植修复短节段缺损进行了比较，并研究了该方法是否可用于支持更长间隙的神经再生，以及短神经段的插入（踏脚石法）在该模型中是否适用。
采用纵向缝合修复大鼠坐骨神经7毫米和15毫米的间隙。在7毫米组中与自体神经移植进行对侧比较，在15毫米组中与缝合加短段插入神经进行对侧比较。在2周、4周和12周时，通过对施万细胞、神经丝蛋白和巨噬细胞进行免疫细胞化学分析来评估神经再生情况，在12周时还通过组织学检查进行评估，包括对胫骨干远端进行形态测量和对腓肠肌进行强直收缩力测量。
作者发现，采用纵向聚乙醇酸缝线修复短节段缺损后的神经再生结果与使用自体神经移植的结果无显著差异。在跨越更长间隙的缝合处虽再生情况较差，但仍有神经再生，并且在该模型中，作为施万细胞来源的插入神经段可显著促进神经再生。
