Mu Liancai, Chen Jingming, Sobotka Stanislaw, Li Jing, Nyirenda Themba
Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey.
J Reconstr Microsurg. 2023 Nov;39(9):695-704. doi: 10.1055/s-0043-1764487. Epub 2023 Mar 22.
We have developed a novel muscle reinnervation technique called "nerve-muscle-endplate grafting (NMEG) in the native motor zone (NMZ)." This study aimed to augment the outcomes of the NMEG-NMZ (NN) by focal application of exogenous neurotrophic factors (ENFs) for limb reinnervation.
Adult rats were used to conduct NN plus ENF (NN/ENF) and autologous nerve grafting (ANG, technique control). The nerve innervating the left tibialis anterior (TA) muscle was resected and the denervated TA was immediately treated with NN/ENF or ANG. For NN procedure, an NMEG pedicle was taken from the lateral gastrocnemius muscle and transferred to the NMZ of the denervated TA. For ANG, the nerve gap was bridged with sural nerve. Three months after treatment, the extent of functional and neuromuscular recovery was assessed by measuring static toe spread, maximal muscle force, wet muscle weight, regenerated axons, and innervated motor endplates (MEPs).
NN/ENF resulted in 90% muscle force recovery of the treated TA, which is far superior to ANG (46%) and NN alone (79%) as reported elsewhere. Toe spread recovered up to 89 and 49% of the control for the NN/ENF and ANG groups, respectively. The average wet muscle weight was 87 and 52% of the control for muscles treated with NN/ENF and ANG, respectively. The mean number of the regenerated axons was 88% of the control for the muscles treated with NN/ENF, which was significantly larger than that for the ANG-repaired muscles (39%). The average percentage of the innervated MEPs in the NN/ENF-treated TA (89%) was higher compared with that in the ANG-repaired TA (48%).
ENF enhances nerve regeneration and MEP reinnervation that further augment outcomes of NN. The NN technique could be an alternative option to treat denervated or paralyzed limb muscles caused by traumatic nerve injuries or lesions.
我们开发了一种名为“原位运动区神经 - 肌肉终板移植（NMEG）”的新型肌肉再支配技术。本研究旨在通过局部应用外源性神经营养因子（ENFs）促进肢体再支配，以增强NMEG原位运动区（NN）技术的效果。
使用成年大鼠进行NN联合ENF（NN/ENF）和自体神经移植（ANG，技术对照）实验。切除支配左胫前肌（TA）的神经，对失神经支配的TA立即进行NN/ENF或ANG治疗。对于NN手术，从外侧腓肠肌获取NMEG蒂并转移至失神经支配TA的原位运动区。对于ANG手术，用腓肠神经桥接神经缺损。治疗三个月后，通过测量静态足趾展开、最大肌肉力量、湿肌肉重量、再生轴突和支配的运动终板（MEP）来评估功能和神经肌肉恢复程度。
NN/ENF治疗后，TA肌肉力量恢复达90%，远优于ANG组（46%）和单独NN组（79%，其他研究报道）。NN/ENF组和ANG组的足趾展开分别恢复至对照的89%和49%。NN/ENF和ANG治疗的肌肉平均湿肌肉重量分别为对照的87%和52%。NN/ENF治疗肌肉的再生轴突平均数量为对照的88%，显著高于ANG修复的肌肉（39%）。NN/ENF治疗的TA中支配的MEP平均百分比（89%）高于ANG修复的TA（48%）。
ENF可促进神经再生和MEP再支配，进一步增强NN技术的效果。NN技术可能是治疗创伤性神经损伤或病变导致的失神经支配或瘫痪肢体肌肉的一种替代选择。
