Ouyang Lian, Zhang Fan, Liu Junjian, Cui Shumin, Chen Keying, Wang Jianguang, Zhou Lihui
Department of Orthopaedic Surgery, Xiangshan First People's Hospital, Ningbo, China.
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Ann Transl Med. 2020 Oct;8(20):1300. doi: 10.21037/atm-20-6526.
Autologous nerve transplantation has become the gold standard for other nerve repair methods. But conventional epineurial sutures is prone to misaligned sutures, erroneous axonal growth, and unsatisfactory repair. Finding a new, more effective nerve coaptation method to improve the efficacy of peripheral nerve repair remains an urgent clinical challenge. In this study, the repair efficacies of oblique nerve coaptations for sciatic nerve injury at various angles were observed, providing a theoretical foundation for further clinical applications.
Sixty-four Sprague-Dawley rats were randomized into four groups of 16. The autologous nerve transplantation model was established by severing and rejoining in situ a 10-mm segment of the sciatic nerve trunk at the angle of 30° (group A), 45° (group B), 60° (group C), or 90° (group D). Sciatic function index (SFI) measurement, measurement of the recovery rate of the wet weight of the triceps surae, electrophysiological examination of nerves, histological examinations, and image analysis were carried out 12 weeks after surgery.
The SFI, the recovery rate of the wet weight of the triceps surae, the electrophysiological function of nerves, histological examinations, and image analysis 12 weeks after surgery indicated that all indices of groups A and B were significantly better than those of groups C and D (P<0.05). There was no significant difference between groups A and B or between groups C and D (P>0.05), although group C exhibited a trend of better recovery than group D.
Oblique nerve coaptation at 30-45° in autologous nerve transplantation may significantly enhance nerve regeneration.
自体神经移植已成为其他神经修复方法的金标准。但传统的神经外膜缝合容易出现缝合错位、轴突生长错误以及修复效果不理想的情况。寻找一种新的、更有效的神经对接方法以提高周围神经修复的疗效仍然是一项紧迫的临床挑战。在本研究中，观察了不同角度的坐骨神经损伤斜行神经对接修复效果，为进一步临床应用提供理论基础。
将64只Sprague-Dawley大鼠随机分为四组，每组16只。通过在坐骨神经干10毫米节段处以30°（A组）、45°（B组）、60°（C组）或90°（D组）的角度切断并原位重新连接建立自体神经移植模型。术后12周进行坐骨神经功能指数（SFI）测量、腓肠肌湿重恢复率测量、神经电生理检查、组织学检查及图像分析。
术后12周的SFI、腓肠肌湿重恢复率、神经电生理功能、组织学检查及图像分析表明，A组和B组的所有指标均显著优于C组和D组（P<0.05）。A组和B组之间以及C组和D组之间无显著差异（P>0.05），尽管C组显示出比D组更好的恢复趋势。
自体神经移植中30-45°的斜行神经对接可能显著促进神经再生。
