Kotulska Katarzyna, Marcol Wiesław, Larysz-Brysz Magdalena, Tendera Zofia, Malinowska-Kołodziej Izabela, Slusarczyk Wojciech, Jedrzejowska-Szypułka Halina, Lewin-Kowalik Joanna
Department of Neurology, Medical University of Silesia, Katowice, Poland.
Microsurgery. 2006;26(8):579-84. doi: 10.1002/micr.20290.
Current methods of peripheral nerve repair are to rejoin cut nerve stumps directly or to bridge large gaps with autologous nerve grafts. In both cases the surface of nerve stump endings is typically cut perpendicularly to the long axis of the nerve. The outcome of such operations, however, is still not satisfactory. In this study, we examine the effect of oblique nerve cutting and grafting on morphological as well as functional features of regeneration. In adult rats, sciatic nerve was cut and rejoined either directly or using an autologous graft, at 90 degrees or 30 degrees angle. Functional regeneration was assessed by walking track analysis during 12-week follow-up. Afterwards muscle weight was measured and histological studies were performed. The latter included nerve fibers and Schwann cells counting, as well as visualization of scar formation and epineural fibrosis. Nerves cut obliquely and rejoined showed better functional recovery than perpendicularly transected. Similar effect was observed after oblique grafting when compared to perpendicular one. Numbers of nerve fibers growing into the distal stump of the nerve as well as the number of Schwann cells were significantly higher in obliquely than in perpendicularly operated nerves. Moreover, growing axons were arranged more regularly following oblique treatment. These data indicate that joining or grafting the nerve stumps at acute angle is a more profitable method of nerve repair than the standard procedure performed at right angle.
目前外周神经修复的方法是直接将切断的神经残端重新连接，或者用自体神经移植物桥接较大的间隙。在这两种情况下，神经残端末端的表面通常垂直于神经的长轴进行切割。然而，这类手术的效果仍不尽人意。在本研究中，我们研究了斜向神经切断和移植对再生的形态学和功能特征的影响。在成年大鼠中，切断坐骨神经，然后以90度或30度角直接重新连接或使用自体移植物重新连接。在12周的随访期间，通过行走轨迹分析评估功能再生情况。之后测量肌肉重量并进行组织学研究。后者包括神经纤维和施万细胞计数，以及瘢痕形成和神经外膜纤维化的可视化。斜向切断并重新连接的神经显示出比垂直横断更好的功能恢复。与垂直移植相比，斜向移植后也观察到类似的效果。斜向手术的神经中长入神经远端残端的神经纤维数量以及施万细胞数量明显高于垂直手术的神经。此外，斜向处理后生长的轴突排列更规则。这些数据表明，与以直角进行的标准手术相比，以锐角连接或移植神经残端是一种更有效的神经修复方法。
