Arnaoutoglou Christina M, Sakellariou Aikaterini, Vekris Marios, Mitsionis Grigoris I, Korompilias Anastasios, Ioakim Elli, Harhantis Antonia, Beris Alexandros
Department of Orthopedic Surgery, University of Ioannina, Ioannina, Greece.
Microsurgery. 2006;26(4):253-61. doi: 10.1002/micr.20236.
The purpose of this study was to assess the maximum rapid intraoperative elongation of the rat sciatic nerve with the use of tissue expander, and its possible functional recovery. One hundred and eight rats were divided into five groups, and their right sciatic nerves were expanded with a 10-cc, 12-cc, 14-cc, 16-cc, and 18-cc expander, respectively, for 1 h. The functional recovery of the nerve was assessed at intervals up to 3 months, using the sciatic function index (SFI), neurophysiological indices, and histology. The maximum intraoperative elongation was observed in group IV (16-cc volume of tissue expander), at about 23.83%. SFI decreased between the first and seventh postoperative days, but gradually recovered, reaching preoperative values in all groups according to the formulas of De Medinaceli et al. (Exp. Neurol. 77:634-643, 1982) and Bain et al. (Plast. Reconstr. Surg. 83:129-136, 1989). Latency and motor conduction velocity demonstrated deterioration after expansion, which peaked after surgery. Recovery was gradually completed by the end of the experiment. The histological findings indicated minor aberrations immediately after expansion and maximal demyelination with axonal disruption on day 15. The reparative process started by day 30 and continued until day 90, when almost no histological changes were observed. In conclusion, intraoperative nerve expansion successfully elongates the rat sciatic nerve up to 23.83%. But it causes functional and morphological abnormalities, which are of moderate to severe degree, are of short duration, and are reversible. Intraoperative nerve expansion might be a valuable solution in the treatment of short nerve gaps, but its clinical application still needs to be evaluated.
本研究的目的是评估使用组织扩张器时大鼠坐骨神经在术中的最大快速延长情况及其可能的功能恢复。108只大鼠被分为五组，分别用10毫升、12毫升、14毫升、16毫升和18毫升的扩张器对其右侧坐骨神经进行扩张1小时。使用坐骨神经功能指数（SFI）、神经生理学指标和组织学，在长达3个月的时间间隔内评估神经的功能恢复情况。在第四组（16毫升组织扩张器组）观察到术中最大延长，约为23.83%。术后第1天至第7天SFI下降，但逐渐恢复，根据德梅迪纳塞利等人（《实验神经病学》77:634 - 643, 1982）和贝恩等人（《整形重建外科》83:129 - 136, 1989）的公式，所有组均恢复到术前值。潜伏期和运动传导速度在扩张后显示恶化，术后达到峰值。到实验结束时逐渐完成恢复。组织学结果表明，扩张后立即有轻微异常，第15天出现最大程度的脱髓鞘和轴突中断。修复过程在第30天开始并持续到第90天，此时几乎未观察到组织学变化。总之，术中神经扩张成功地将大鼠坐骨神经延长了23.83%。但它会导致功能和形态异常，这些异常程度为中度至重度，持续时间短且可逆。术中神经扩张可能是治疗短神经间隙的一种有价值的解决方案，但其临床应用仍需评估。
