Skouras Emmanouil, Merkel Daniel, Grosheva Maria, Angelova Srebrina K, Schiffer Gereon, Thelen Ulrich, Kaidoglou Katerina, Sinis Nektarios, Igelmund Peter, Dunlop Sarah A, Pavlov Stoyan, Irintchev Andrey, Angelov Doychin N
Department of Trauma, Hand and Reconstructive Surgery, University of Cologne, Cologne, Germany.
Restor Neurol Neurosci. 2009;27(3):237-51. doi: 10.3233/RNN-2009-0474.
The outcome of peripheral nerve injuries requiring surgical repair is poor. Recent work suggested that electrical stimulation (ES) of the proximal nerve stump to produce repeated discharges of the parent motoneurons for one hour could be a beneficial therapy if delivered immediately prior to reconstructive surgery of mixed peripheral nerves.
We tested whether ES has a positive influence on functional recovery after repair of a purely motor nerve, the facial nerve.
Electrical stimulation (20 Hz) was delivered to the proximal nerve stump of the transected facial nerve for 1 hour prior to nerve reconstruction by end-to-end suture (facial-facial anastomosis, FFA). For manual stimulation (MS), animals received daily rhythmic stroking of the whisker pads. Restoration of vibrissal motor performance following ES or MS was evaluated using video-based motion analysis. We also assessed the degree of collateral axonal branching at the lesion site, by counting motoneuronal perikarya after triple retrograde labeling, and estimated the quality of motor end-plate reinnervation in the target musculature. Outcomes at 4 months were compared to animals receiving sham stimulation (SS) or MS.
Neither protocol reduced the degree of collateral sprouting. ES did not improve functional outcome and failed to reduce the proportion of polyinnervated motor end-plates. By contrast, MS restored normal whisking function and reduced polyinnervation.
Whereas acute ES is not beneficial for facial nerve repair, MS provides long-term benefits.
需要手术修复的周围神经损伤预后较差。最近的研究表明,如果在混合周围神经重建手术前立即对近端神经残端进行电刺激(ES),使母运动神经元重复放电一小时,可能是一种有益的治疗方法。
我们测试了ES对纯运动神经(面神经)修复后功能恢复是否有积极影响。
在通过端端缝合(面-面吻合术,FFA)进行神经重建前,对横断的面神经近端神经残端给予1小时的电刺激(20Hz)。对于手动刺激(MS),动物每天接受有节奏的触须垫抚摸。使用基于视频的运动分析评估ES或MS后触须运动性能的恢复情况。我们还通过对三重逆行标记后的运动神经元胞体计数,评估损伤部位的侧支轴突分支程度,并估计靶肌肉组织中运动终板再支配的质量。将4个月时的结果与接受假刺激(SS)或MS的动物进行比较。
两种方案均未降低侧支芽生的程度。ES并未改善功能结局,也未能降低多神经支配运动终板的比例。相比之下,MS恢复了正常的触须功能并减少了多神经支配。
急性ES对面神经修复无益,而MS则具有长期益处。