Zhang Zijie, Johnson Elizabeth O, Vekris Marios D, Zoubos Aristides B, Bo Jinyan, Beris Alexandros E, Soucacos Panayotis N
Department of Orthopedic Surgery, School of Medicine, University of Athens, Athens, Greece.
Microsurgery. 2006;26(4):245-52. doi: 10.1002/micr.20235.
The aim of this study was to assess the effectiveness of reinnervation using end-to-side neurorrhaphy in the upper extremity of the rabbit. The cut right ulnar nerve was repaired and sutured to the side of the median nerve about 3 cm above the elbow joint. The extent of reinnervation was quantitatively evaluated, as well as the integrity of the intact donor nerve in 36 rabbits randomly treated with fresh or delayed nerve repair with or without perineurotomy. Evaluations included nerve conduction velocity (NCV) of both the ulnar and medial nerves, dry muscle weight, and histologic examination (neurofilament stain and morphometric assessment) at 3 and 6 months postoperatively. NCV recovery rates were 79% and 87% for the ulnar nerve, and 89% and 94% for the median nerve compared to contralateral intact nerves, at 3 and 6 months, respectively. Flexor carpi ulnaris muscle mass measurements revealed a recovery in dry muscle weight of about 81% and 88% at 3 and 6 months, respectively, compared to the intact contralateral flexor carpi ulnaris. Histologic studies with neurofilament staining reveal numerous axonal sprouts at the distal end of the median nerve, indicative of myelinated axonal regeneration. Morphometric analysis demonstrated no difference between fresh and delayed repairs. These results indicate that in the upper extremity of rabbits, end-to-side neurorrhaphy permits axonal regeneration from the intact donor nerve, and is associated with satisfactory recovery. The effect of the procedure on the donor nerve was negligible.
本研究的目的是评估端侧神经缝合术在上肢兔神经再支配中的有效性。将右侧切断的尺神经修复并缝合至肘关节上方约3厘米处的正中神经侧面。对36只随机接受新鲜或延迟神经修复（伴或不伴神经外膜切开术）的兔子，定量评估神经再支配的程度以及完整供体神经的完整性。评估内容包括术后3个月和6个月时尺神经和正中神经的神经传导速度（NCV）、肌肉干重以及组织学检查（神经丝染色和形态计量评估）。与对侧完整神经相比，术后3个月和6个月时，尺神经的NCV恢复率分别为79%和87%，正中神经的NCV恢复率分别为89%和94%。尺侧腕屈肌肌肉质量测量显示，与对侧完整的尺侧腕屈肌相比，术后3个月和6个月时肌肉干重分别恢复了约81%和88%。神经丝染色的组织学研究显示，正中神经远端有大量轴突发芽，表明有髓轴突再生。形态计量分析表明新鲜修复和延迟修复之间没有差异。这些结果表明，在上肢兔中，端侧神经缝合术可使轴突从完整的供体神经再生，并伴有满意的恢复。该手术对供体神经的影响可忽略不计。
