Frey M, Koller R, Gruber I, Liegl C, Bittner R, Gruber H
Department of Surgery, University Hospital, Zurich, Switzerland.
J Reconstr Microsurg. 1992 Sep;8(5):345-57. doi: 10.1055/s-2007-1006717.
In 15 adult sheep, the saphenous nerve (28 +/- 1.8 cm) was used for ipsilateral or for cross-nerve grafting and was sutured to the proximal stump of the cut, motor-nerve branch of the vastus muscle. The distal end of the nerve graft was left without a target organ. Semi-thin cross sections of normal vastus nerves and saphenous grafts and of the distal ends of the grafts were analyzed by computer-assisted planimetry, 3, 6, 9, 12, and 18 months after the nerve-grafting procedure. Electronmicroscopy was also performed on specimens from the distal ends of the nerve grafts. Comparing the total number of myelinated nerve fibers in the distal end of the graft, the ipsilateral group showed an increase with time elapsed since nerve grafting, while the cross-over group showed a maximum after 3 and 6 months, and fewer fibers after longer periods of regeneration. Independent of the time passed since nerve grafting, the diameters of the myelinated nerve fibers were homogeneously thin in both experimental groups. Most interesting, the cross-nerve grafts did more poorly than the ipsilateral ones, even before they were influenced by the target muscle. With ultrastructural investigation, the ends of the grafts containing only a few myelinated fibers also showed a low number of unmyelinated fibers, but an increase of collagen fibers. The results have consequences for the clinical application of cross-nerve grafting.
在15只成年绵羊中，使用隐神经（28±1.8厘米）进行同侧或交叉神经移植，并将其缝合到切断的股四头肌运动神经分支的近端残端。神经移植物的远端没有连接靶器官。在神经移植术后3、6、9、12和18个月，通过计算机辅助平面测量法对正常股神经、隐神经移植物以及移植物远端的半薄切片进行分析。还对神经移植物远端的标本进行了电子显微镜检查。比较移植物远端有髓神经纤维的总数，同侧组显示自神经移植后随着时间推移数量增加，而交叉组在3个月和6个月时达到最大值，再生时间更长后纤维数量减少。与神经移植后的时间无关，两个实验组中有髓神经纤维的直径均均匀细小。最有趣的是，即使在交叉神经移植物受到靶肌肉影响之前，其表现也比同侧移植物差。通过超微结构研究发现，仅含有少量有髓纤维的移植物末端无髓纤维数量也较少，但胶原纤维有所增加。这些结果对交叉神经移植的临床应用具有启示意义。
