Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Orthopedic Surgery, the Affiliated Hospital of Medical College, Qingdao University, Shandong, China.
Microsurgery. 2014 Feb;34(2):136-44. doi: 10.1002/micr.22167. Epub 2013 Sep 6.
End-to-side (ETS) neurorrhaphy has been applied in the repair of peripheral nerve injuries and in babysitter procedures. However, the long-term changes of donor nerve and muscle after ETS remain unknown. This study was designed to investigate long-term changes in donor nerve and muscle in a rat model. Sixty Lewis rats were equally allocated into three groups of 20 rats. The peroneal nerve was divided. In Group A, end-to-end (ETE) neurorrhaphy was performed. In Group B, ETS was performed to an epineurial window on the tibial nerve. In Group C, ETS was performed to the tibial nerve with 40% partial neurectomy. The following data were obtained at 6, 12, 18, and 24 weeks postoperatively: latency delaying rate (LDR), amplitude recovery rate (ARR), myelinated fiber counts, muscle force and weight, and cross-sectional area of gastrocnemius muscle fibers. The results showed no significant changes of the donor nerve and muscle in Group B. Nerve regeneration was found in the peroneal nerve, and myelinated fiber number was significantly decreased when compared to the nerve with ETE. In Group C, the myelinated axon number in the peroneal nerve was equivalent to the level in ETE repair. However, function and structure of the donor nerve and muscle were significantly impaired in the early postoperative period. Nonetheless, full recovery was observed 24 weeks after surgery. Both ETS with epineurial window and 40% donor nerve neurectomy showed reinnervation of the recipient nerve without structural and functional changes of the donor system in a long-term follow-up. Partial neurectomy may promote recipient nerve regeneration, but at the cost of donor neuromuscular compromises in the early postoperative period. This study provides long-term evidence for further investigation of ETS in peripheral nerve repair and in babysitter procedures.
端侧吻合（ETS）已被应用于周围神经损伤和桥接手术的修复。然而，ETS 后供体神经和肌肉的长期变化尚不清楚。本研究旨在探讨大鼠模型中供体神经和肌肉的长期变化。60 只Lewis 大鼠被平均分配到 3 组，每组 20 只。腓总神经被切断。在 A 组，进行端端吻合（ETE）神经吻合。在 B 组，在胫神经的神经外膜窗进行 ETS。在 C 组，对 40%部分神经切除的胫神经进行 ETS。术后 6、12、18 和 24 周分别获得以下数据：潜伏期延迟率（LDR）、振幅恢复率（ARR）、有髓纤维计数、肌肉力量和重量以及腓肠肌纤维的横截面积。结果显示 B 组供体神经和肌肉无明显变化。腓总神经再生，有髓纤维数量明显减少，与 ETE 相比。在 C 组，腓总神经中的有髓轴突数量与 ETE 修复相当。然而，供体神经和肌肉的功能和结构在术后早期受到严重损害。尽管如此，术后 24 周观察到完全恢复。神经外膜窗的 ETS 和 40%供体神经神经切除术均显示出受神经的再神经支配，而供体系统在长期随访中无结构和功能变化。部分神经切除术可能促进受神经的再生，但以术后早期供体神经肌肉受损为代价。本研究为进一步研究 ETS 在周围神经修复和桥接手术中的应用提供了长期证据。
