Yao Ping, Li Peng, Jiang Jun-Jian, Li Hong-Ye
Department of Hand Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou, Zhejiang Province, China.
Department of Anesthesia, Affiliated Puai Hospital of Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Neural Regen Res. 2018 Feb;13(2):309-316. doi: 10.4103/1673-5374.226401.
Scar hyperplasia at the suture site is an important reason for hindering the repair effect of peripheral nerve injury anastomosis. To address this issue, two repair methods are often used. Biological agents are used to block nerve sutures and the surrounding tissue to achieve physical anti-adhesion effects. Another agent is glucocorticosteroid, which can prevent scar growth by inhibiting inflammation. However, the overall effect of promoting regeneration of the injured nerve is not satisfactory. In this regard, we envision that these two methods can be combined and lead to shared understanding for achieving improved nerve repair. In this study, the right tibial nerve was transected 1 cm above the knee to establish a rat tibial nerve injury model. The incision was directly sutured after nerve transection. The anastomotic stoma was coated with 0.5 × 0.5 cm chitosan sheets with betamethasone dipropionate. At 12 weeks after injury, compared with the control and poly (D, L-lactic acid) groups, chitosan-betamethasone dipropionate film slowly degraded with the shape of the membrane still intact. Further, scar hyperplasia and the degree of adhesion at anastomotic stoma were obviously reduced, while the regenerated nerve fiber structure was complete and arranged in a good order in model rats. Electrophysiological study showed enhanced compound muscle action potential. Our results confirm that chitosan-betamethasone dipropionate film can effectively prevent local scar hyperplasia after tibial nerve repair and promote nerve regeneration.
缝合部位的瘢痕增生是阻碍周围神经损伤吻合修复效果的重要原因。为解决这一问题,常采用两种修复方法。生物制剂用于阻断神经缝合处及其周围组织,以达到物理防粘连效果。另一种制剂是糖皮质激素,它可通过抑制炎症来防止瘢痕生长。然而,促进损伤神经再生的总体效果并不理想。在这方面,我们设想可以将这两种方法结合起来,以达成对改善神经修复的共同理解。在本研究中,将大鼠右胫神经在膝关节上方1 cm处横断,建立大鼠胫神经损伤模型。神经横断后直接缝合切口。在吻合口处涂抹0.5×0.5 cm的含二丙酸倍他米松的壳聚糖片。损伤后12周,与对照组和聚(D,L-乳酸)组相比,含二丙酸倍他米松的壳聚糖膜缓慢降解,膜的形状仍保持完整。此外,模型大鼠吻合口处的瘢痕增生和粘连程度明显减轻,而再生神经纤维结构完整且排列有序。电生理研究显示复合肌肉动作电位增强。我们的结果证实,含二丙酸倍他米松的壳聚糖膜可有效防止胫神经修复后局部瘢痕增生并促进神经再生。