Liu Hai-Fei, Chen Zeng-Gan, Lineaweaver William C, Zhang Feng
Shandong and Shanghai, People's Republic of China; and Jackson, Miss.
From the Department of Orthopedic Surgery, the Affiliated Hospital of Qingdao University; the Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University; and the Joseph M. Still Burn and Reconstructive Center.
Plast Reconstr Surg. 2016 Jul;138(1):122-131. doi: 10.1097/PRS.0000000000002292.
The authors evaluated the long-term efficacy of the "babysitter" procedure in improving nerve regeneration and denervated muscle atrophy for peripheral nerve repair.
Eighty Lewis rats were allocated equally into four groups. The peroneal nerves of all animals were divided. In group A, the peroneal nerve stumps were anchored into adjacent muscles. Rats in group B underwent end-to-end neurorrhaphy. Rats in group C underwent end-to-side neurorrhaphy of the distal peroneal nerve stump to an epineurial window on the tibial nerve. Rats in group D underwent end-to-side neurorrhaphy of the distal stump to the tibial nerve with 40 percent neurectomy. After 8 weeks, end-to-end neurorrhaphy of the peroneal nerve stumps was performed in group A, C, and D during a second-stage procedure. Electrophysiology, myelinated fiber counts, muscle force and weight, and muscle histomorphometry were analyzed at 4, 8, 12, and 24 weeks postoperatively.
At 4 weeks, the end-to-end group showed predominant advantages in nerve regeneration and muscle preservation. No differences were observed in the latency delaying rate, tetanic tension, myelinated fiber number, or muscle weight between groups B and D by 24 weeks (p > 0.05). At 24 weeks, the results revealed superior latency delaying rate, myelinated axon regeneration, and size of muscle fibers in group D as compared with group C.
Peripheral nerve repair with an initial motor nerve babysitter with 40 percent neurectomy of the donor nerve can achieve high efficacy in functional and structural recovery of the recipient system. Nerve babysitter by motor nerve with an epineural window was less effective.
作者评估了“保姆”手术在改善周围神经修复中神经再生和失神经肌肉萎缩方面的长期疗效。
80只Lewis大鼠平均分为四组。所有动物的腓总神经均被切断。A组将腓总神经残端固定于相邻肌肉。B组进行端端神经缝合。C组将腓总神经远端残端与胫神经的神经外膜窗口进行端侧神经缝合。D组将远端残端与胫神经进行端侧神经缝合，并对供体神经进行40%的神经切除术。8周后，在第二阶段手术中对A、C、D组的腓总神经残端进行端端神经缝合。术后4、8、12和24周分析电生理、有髓纤维计数、肌肉力量和重量以及肌肉组织形态学。
4周时，端端缝合组在神经再生和肌肉保存方面显示出主要优势。到24周时，B组和D组在潜伏期延迟率、强直张力、有髓纤维数量或肌肉重量方面未观察到差异（p>0.05）。24周时，结果显示D组与C组相比，潜伏期延迟率、有髓轴突再生和肌纤维大小更优。
最初采用运动神经保姆并对供体神经进行40%神经切除术的周围神经修复，可在受体系统的功能和结构恢复方面取得高效。通过带神经外膜窗口的运动神经进行神经保姆操作效果较差。
