Kürklü Mustafa, Demiralp Bahtiyar, Kirdemir Vecihi, Kömürcü Mahmut, Ulaş Umit Hidir, Oztaş Emin, Ateşalp A Sabri, Başbozkurt Mustafa
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Anabilim Dali), Gülhane Military School of Medicine, Ankara, Turkey.
Acta Orthop Traumatol Turc. 2005;39(2):163-71.
We compared the electrophysiologic and histopathologic results of grafting and distraction methods in the treatment of defective peripheral neural injuries.
Thirty male white rabbits (age 6 months) were divided into three groups and a circular external fixator (CEF) was applied to the right tibias. In group I (primary repair), the right deep peroneal nerve was cut without inducing any defect and a tibial osteotomy was performed. The remaining groups underwent bone and nerve excision of about 1 cm in the middle third of the tibia. In group II, the defect area was closed acutely with the CEF and the continuity of the nerve was restored. In group III, a nerve graft obtained from the left side was placed in the defect area and an epiperineural repair was made. Group II underwent distraction 21 days after surgery for 10 days with a rate of 0.25 mm four times a day. Electrophysiological studies were performed in the 12th and 24th weeks and nerve biopsies were obtained in the 32nd week for histopathologic examination.
Electrophysiological studies in the 12th week did not show any significant differences in nerve conduction between the three groups; however, in the 24th week, amplitude and latency values of the graft group were 50% lower than those of the primary repair and distraction groups (p<0.05). On histological examination, the results were good in group I and II, but poor in group III with respect to nerve fiber density, thickness of the myelin sheath, degenerative changes in the myelin sheath, and average axon number.
Our data demonstrate that treatment of neural defects by the distraction method results in much better results than the grafting method.
我们比较了移植和牵张方法在治疗周围神经损伤缺损中的电生理和组织病理学结果。
将30只6个月大的雄性白兔分为三组，并在其右胫骨上应用环形外固定器（CEF）。第一组（一期修复）切断右腓深神经但不造成任何缺损，并进行胫骨截骨术。其余两组在胫骨中1/3处进行约1cm的骨和神经切除。第二组用CEF急性闭合缺损区域并恢复神经连续性。第三组将从左侧获取的神经移植物置于缺损区域并进行神经外膜修复。第二组在术后21天开始牵张，持续10天，牵张速率为每天4次，每次0.25mm。在第12周和第24周进行电生理研究，并在第32周获取神经活检组织进行组织病理学检查。
第12周的电生理研究显示三组之间神经传导无显著差异；然而，在第24周，移植组的波幅和潜伏期值比一期修复组和牵张组低50%（p<0.05）。组织学检查显示，第一组和第二组结果良好，但第三组在神经纤维密度、髓鞘厚度、髓鞘退变改变和平均轴突数量方面结果较差。
我们的数据表明，牵张方法治疗神经缺损的效果比移植方法好得多。
