Frey M, Gruber H, Happak W, Girsch W, Gruber I, Koller R
Surgical Department, University Hospital of Zürich, Switzerland.
Plast Reconstr Surg. 1990 Jan;85(1):77-89; discussion 90-1. doi: 10.1097/00006534-199001000-00014.
In difficult reconstructions, ipsilateral or cross-over nerve grafting is sometimes necessary to achieve reinnervation and motor function. This experimental study in sheep was to answer the question of limitation of elongation of a motor nerve by grafting, the question of the optimal time for suturing the nerve graft to the muscle nerve, and the question of the successful application of this surgical technique in extremities. In 18 sheep, the vastus nerve was elongated by a saphenous nerve graft as long as possible up to 30 cm (step 1). In 10 animals the nerve graft was applied ipsilaterally, and in 8 animals it was used as a cross-over nerve graft to the contralateral limb. The time between nerve grafting and connection of the distal end of the nerve graft to the freshly cut rectus nerve supplying the rectus femoris muscle (step 2) was variable: 0, 3, 6, 9, and 12 months. In all animals, the final experiments (step 3) were performed 6 months after the last operation (step 2). Muscle force measurements in the rectus femoris muscle and quantitative analysis of the number and diameter of myelinated nerve fibers in cross sections of the nerve biopsies at different levels showed that elongation of a motor nerve by nerve grafting is principally not limited. The functional results were rather inhomogeneous and therefore unpredictable (ipsilateral group: maximum tetanic tension = 27 to 172 N; cross-over group: 0 to 227.5 N). Nevertheless, crossover nerve grafting is recommended for selected cases even in extremities. There was no correlation between the time interval between the two operations and the functional or morphologic results, although better functional results were obtained when the distal nerve suture (step 2) was performed some months after nerve grafting (step 1). A clear correlation was found only between the number of regenerated axons in the rectus nerve behind the second suture line and the muscle function.
在复杂的重建手术中，有时需要进行同侧或交叉神经移植以实现神经再支配和运动功能。这项在绵羊身上进行的实验研究旨在回答以下问题：通过移植延长运动神经的限度、将神经移植物缝合到肌肉神经的最佳时间，以及这种手术技术在四肢成功应用的问题。在18只绵羊中，尽可能用隐神经移植物延长股神经，最长可达30厘米（步骤1）。10只动物采用同侧神经移植，8只动物采用交叉神经移植至对侧肢体。从神经移植到将神经移植物远端连接到新切断的供应股直肌的直神经之间的时间（步骤2）各不相同：0、3、6、9和12个月。在所有动物中，最终实验（步骤3）在最后一次手术（步骤2）6个月后进行。股直肌的肌力测量以及不同水平神经活检切片中有髓神经纤维数量和直径的定量分析表明，通过神经移植延长运动神经原则上没有限度。功能结果相当不均匀，因此不可预测（同侧组：最大强直张力 = 27至172牛；交叉组：0至227.5牛）。尽管如此，即使在四肢，对于某些选定的病例仍推荐采用交叉神经移植。两次手术之间的时间间隔与功能或形态学结果之间没有相关性，尽管在神经移植（步骤1）几个月后进行远端神经缝合（步骤2）时可获得更好的功能结果。仅在第二条缝合线后方的直神经中再生轴突的数量与肌肉功能之间发现了明显的相关性。
