Attar Bijan Movahedian, Zalzali Haidar, Razavi Mohammad, Ghoreishian Mehdi, Rezaei Majid
Department of Oral and Maxillofacial Surgery and Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
J Oral Maxillofac Surg. 2012 Oct;70(10):2427-32. doi: 10.1016/j.joms.2011.11.007. Epub 2012 Jan 28.
Epineural suturing is the most common technique used for peripheral nerve anastomosis. In addition to the foreign body reaction to the suture material, the surgical duration and difficulty of suturing in confined anatomic locations are major problems. We evaluated the effectiveness of fibrin glue as an acceptable alternative for nerve anastomosis in dogs.
Eight adult female dogs weighing 18 to 24 kg were used in the present study. The facial nerve was transected bilaterally. On the right side, the facial nerve was subjected to epineural suturing; and on the left side, the nerve was anastomosed using fibrin adhesive. After 16 weeks, the nerve conduction velocity and proportion of the nerve fibers that crossed the anastomosis site were evaluated and compared for the epineural suture (right side) and fibrin glue (left side). The data were analyzed using the paired t test and univariate analysis of variance.
The mean postoperative nerve conduction velocity was 29.87 ± 7.65 m/s and 26.75 ± 3.97 m/s on the right and left side, respectively. No statistically significant difference was found in the postoperative nerve conduction velocity between the 2 techniques (P = .444). The proportion of nerve fibers that crossed the anastomotic site was 71.25% ± 7.59% and 72.25% ± 8.31% on the right and left side, respectively. The histologic evaluation showed no statistically significant difference in the proportion of the nerve fibers that crossed the anastomotic site between the 2 techniques (P = .598).
The results suggest that the efficacies of epineural suturing and fibrin gluing in peripheral nerve anastomosis are similar.
神经外膜缝合是周围神经吻合最常用的技术。除了对缝合材料的异物反应外,手术时间以及在受限解剖位置进行缝合的难度是主要问题。我们评估了纤维蛋白胶作为犬神经吻合可接受替代方法的有效性。
本研究使用8只体重18至24千克的成年雌性犬。双侧切断面神经。右侧面神经进行神经外膜缝合;左侧神经使用纤维蛋白粘合剂进行吻合。16周后,评估并比较神经外膜缝合组(右侧)和纤维蛋白胶组(左侧)的神经传导速度以及穿过吻合部位的神经纤维比例。数据采用配对t检验和单因素方差分析。
术后右侧和左侧的平均神经传导速度分别为29.87±7.65米/秒和26.75±3.97米/秒。两种技术术后神经传导速度差异无统计学意义(P = 0.444)。右侧和左侧穿过吻合部位的神经纤维比例分别为71.25%±7.59%和72.25%±8.31%。组织学评估显示,两种技术在穿过吻合部位的神经纤维比例上差异无统计学意义(P = 0.598)。
结果表明,神经外膜缝合和纤维蛋白胶粘合在周围神经吻合中的效果相似。