Jaeger Marcos Ricardo de Oliveira, Braga-Silva Jefferson, Gehlen Daniel, Pereira-Filho Gustavo de Azambuja, Zettler Claudio Galleano, de Souza Maria Antonieta Lopes, Veas Javier Román, Sebben Alessandra
Laboratory of Surgical Technique and Microsurgical Research, Department of Hand Surgery and Reconstructive Microsurgery, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
Ann Plast Surg. 2011 Oct;67(4):391-6. doi: 10.1097/SAP.0b013e3182126816.
The aim of this study was to experimentally compare end-to-end and end-to-side neurorrhaphy in perineural window model after motor nerve lesion, evaluating which one was the most effective to preserve nerves. Also, differences in motor and sensorial nerve regeneration were tested to verify differences in nerve regeneration.
A total of 20 adult male Wistar rats were randomly assigned to 5 groups, and, in each one, a different treatment was performed: besides the control group, and end-to-end or end-to-side graft with motor or sensorial nerves was performed. Silastic sheet was used as a mechanical barrier to prevent innervation from adjacent nerves. After 16 weeks, the specimens were histologically assessed and wet weight was evaluated as a direct parameter of atrophy.
The end-to-end neurorrhaphy group presented the best results in terms of mass preservation, but it did not differ significantly from the control group. Motor nerves presented similar results in muscular atrophy. The end-to-side neurorrhaphy group with sensory nerve as donor showed the worst results.
The use of sensory nerves to preserve skeletal muscle trophism is not justified, since, according to our model, it affects 50% to 80% of the muscle mass in a period of 16 weeks. End-to-side neurorrhaphy was demonstrated to be an option for re-enervation of a nerve-deprived motor muscle in selected cases.
本研究的目的是在运动神经损伤后的神经周围窗模型中,通过实验比较端端神经缝合术和端侧神经缝合术,评估哪种方法在保护神经方面最有效。此外,还测试了运动神经和感觉神经再生的差异,以验证神经再生的差异。
总共20只成年雄性Wistar大鼠被随机分为5组,每组进行不同的治疗:除了对照组外,还进行了运动神经或感觉神经的端端或端侧移植。使用硅橡胶片作为机械屏障,以防止相邻神经的神经支配。16周后,对标本进行组织学评估,并将湿重作为萎缩的直接参数进行评估。
端端神经缝合术组在质量保存方面表现出最佳结果,但与对照组无显著差异。运动神经在肌肉萎缩方面表现出相似的结果。以感觉神经为供体的端侧神经缝合术组结果最差。
使用感觉神经来维持骨骼肌营养状态是不合理的,因为根据我们的模型,在16周的时间内,它会影响50%至80%的肌肉质量。在特定情况下,端侧神经缝合术被证明是一种对失神经支配的运动肌肉进行再神经支配的选择。