Zhang Qiang, Chen Huihao, Liu Guohui, Zong Haiyang, Lin Haodong, Hou Chunlin
Department of Orthopaedics, Changzheng Hospital of Second Military Medical University, Shanghai, 200003, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 May 8;30(5):608-611. doi: 10.7507/1002-1892.20160123.
To investigate the regularity of myelin degeneration and regeneration and the difference of axonal density between tibial nerve and common peroneal nerve after sciatic nerve injury repair in rhesue monkey.
Nine adult rhesue monkeys (male or female, weighing 3.5-4.5 kg) were selected to establish the model of rat sciatic nerve transaction injury. The tibial nerve and common peroneal nerve of 5 mm in length were harvested at 5 mm from injury site as controls in 3 monkeys; the distal tibial nerve and common peroneal nerve were repaired with 9-0 suture immediately in the other 6 monkeys. And the gross observation and neural electrophysiological examination were performed at 3 and 8 weeks after repair respectively. Then, distal tibial nerve and common peroneal nerve at anastomotic site were harvested to observe the myelin sheath changes, and to calculate the number of axon counts and axonal density by staining with Luxol Fast Blue.
Atrophy of the lower limb muscle and various degrees of plantar ulcer were observed. Gross observation showed nerve enlargement at anastomosis site, the peripheral connective tissue hyperplasia, and obvious adhesion. The compound muscle action potential (CMAP) of tibial nerve and common peroneal nerve could not be detected at 3 weeks; the CMAP amplitude of common peroneal nerve was less than that of the tibial nerve at 8 weeks. Different degrees of axonal degeneration was shown in the tibial nerve and common peroneal nerve, especially in the common peroneal nerve. The average axonal density of common peroneal nerve was lower than that of tibial nerve at 3 weeks (13.2% vs. 44.5%) and at 8 weeks (10.3% vs. 35.3%) after repair.
The regeneration of tibial nerve is better and faster than that of common peroneal nerve, and gastrocnemius muscle CMAP recovers quicker, and amplitude is higher, which is the reason of better recovery of tibial nerve.
探讨恒河猴坐骨神经损伤修复后胫神经和腓总神经髓鞘变性与再生规律以及轴突密度差异。
选取9只成年恒河猴（雌雄不限，体重3.5 - 4.5 kg）建立大鼠坐骨神经切断损伤模型。3只猴子在距损伤部位5 mm处取5 mm长的胫神经和腓总神经作为对照；另外6只猴子立即用9 - 0缝线修复胫神经和腓总神经远端。分别在修复后3周和8周进行大体观察和神经电生理检查。然后，取吻合部位的胫神经和腓总神经远端观察髓鞘变化，并用Luxol Fast Blue染色计算轴突计数和轴突密度。
观察到下肢肌肉萎缩和不同程度的足底溃疡。大体观察显示吻合部位神经增粗，周围结缔组织增生，粘连明显。3周时胫神经和腓总神经复合肌肉动作电位（CMAP）未引出；8周时腓总神经CMAP波幅低于胫神经。胫神经和腓总神经均出现不同程度的轴突变性，尤其是腓总神经。修复后3周（13.2%对44.5%）和8周（10.3%对35.3%）腓总神经平均轴突密度低于胫神经。
胫神经再生较腓总神经更好更快，腓肠肌CMAP恢复更快且波幅更高，这是胫神经恢复较好的原因。
