Viterbo F, Trindade J C, Hoshino K, Mazzoni Neto A
Department of Plastic Surgery, Instituto de Biociencias, Brazil, São Paulo.
Plast Reconstr Surg. 1994 Dec;94(7):1038-47. doi: 10.1097/00006534-199412000-00019.
Terminolateral neurorrhaphies were used up to the beginning of this century. After that, they were no longer reported. We tested the efficacy of a new type of end-to-side neurorrhaphy. A group of 20 rats had the peroneal nerve sectioned, and the distal ending was sutured to the lateral face of the tibial nerve after removing a small epineural window. All experiments were made on the right side, the left one remaining untouched in half the animals of each group. The other half was denervated by sectioning and inverting the endings of the peroneal nerves. In this way, tibial cranial muscles were either normal or denervated on the left side and reinnervated through end-to-side neurorrhaphies on the right side. After 7.8 months, the animals were subjected to electrophysiologic tests, sacrificed, and the nerves and muscles were taken for histologic examination. A response of the tibial cranial muscle was obtained in 90 percent of the animals. The distal ending of the peroneal nerve showed an average of 861 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (microns 2) 1617.81 for M2n (when the contralateral side was normal) and 1579.19 for M2d (when the contralateral was denervated). We conclude that the terminolateral neurorrhaphy is functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The absence of an incision on the axons of the donor nerve was no impediment to axonal regeneration or to the passage of electrical stimuli. The results demonstrate the possibility of using end-to-side and terminolateral neurorrhaphies for reconstituting neural lesions when only a distal end is available; the reinnervation can be obtained from the lateral face of a healthy nerve.
直到本世纪初，人们一直使用端侧神经缝合术。此后，就不再有相关报道了。我们测试了一种新型端侧神经缝合术的疗效。将20只大鼠的腓总神经切断，在去除一小片神经外膜窗口后，将远端断端缝合到胫神经的侧面。所有实验均在右侧进行，每组一半动物的左侧保持不动。另一半通过切断并翻转腓总神经的断端使其失神经支配。这样，左侧的胫前肌要么正常，要么失神经支配，而右侧则通过端侧神经缝合术重新获得神经支配。7.8个月后，对动物进行电生理测试，然后处死，取出神经和肌肉进行组织学检查。90%的动物的胫前肌出现反应。腓总神经的远端断端平均有861根神经纤维。重新获得神经支配的胫前肌的平均面积（平方微米），当对侧正常时M2n为1617.81，当对侧失神经支配时M2d为1579.19。我们得出结论，端侧神经缝合术是有功能的，能够传导电刺激，并允许轴突从健康神经的侧面通过，以重建切断神经的远端部分。供体神经轴突上没有切口并不妨碍轴突再生或电刺激的通过。结果表明，当只有远端可用时，使用端侧和端侧神经缝合术重建神经损伤是可能的；可以从健康神经的侧面获得重新神经支配。
