Hasegawa J, Shibata M, Takahashi H
Department of Orthopaedic Surgery, Niigata University School of Medicine, Japan.
J Hand Surg Am. 1996 Mar;21(2):259-65. doi: 10.1016/S0363-5023(96)80113-4.
Appropriate matching of proximal and distal fibers is a major objective when suturing a lacerated nerve. Recent studies suggest that neurotropic factors may influence motor/sensory specificity and affect the functional outcome. This was studied in animal models by direct coaptation of cut nerve ends inside a 5-mm collagen tube with and without appropriate sensory/motor alignment, as well as in models where the cut nerve ends were placed in a 10-mm collagen tube with a 5-mm gap, with and without appropriate sensory/motor alignment. The radial nerve of 49 New Zealand white rabbits was chosen because it has distinct motor and sensory divisions. The animals were killed at 24 weeks and electrophysiologic, histologic, and muscle contraction studies were performed. Axon counts and diameters were measured from the distal motor and sensory stumps. Nerve conduction velocity, dry muscle weight, and motor axon counts were not statistically different between the groups. The malaligned group without a gap had better regeneration in sensory nerves than other groups. The muscle contraction force of the malaligned group without a gap was significantly less than the other groups. The malaligned group with a 5-mm gap had the same muscle contraction force as the aligned group without a gap. In this study, a short nerve gap lessened the misdirection of motor fibers after nerve-end coaptation.
缝合撕裂的神经时，近端和远端纤维的适当匹配是一个主要目标。最近的研究表明，神经营养因子可能影响运动/感觉特异性并影响功能结果。在动物模型中对此进行了研究，方法是将切断的神经末端直接对接在5毫米的胶原管内，有或没有适当的感觉/运动对齐，以及在切断的神经末端置于10毫米胶原管且有5毫米间隙的模型中，有或没有适当的感觉/运动对齐。选择49只新西兰白兔的桡神经，因为它有明显的运动和感觉分支。在24周时处死动物，并进行电生理、组织学和肌肉收缩研究。测量远端运动和感觉残端的轴突数量和直径。各实验组之间的神经传导速度、肌肉干重和运动轴突数量无统计学差异。无间隙的错配组感觉神经的再生优于其他组。无间隙的错配组的肌肉收缩力明显低于其他组。有5毫米间隙的错配组的肌肉收缩力与无间隙的对齐组相同。在本研究中，短神经间隙减少了神经末端对接后运动纤维的误定向。
