The efficacy of end-to-end and end-to-side nerve repair (neurorrhaphy) in the rat brachial plexus
The efficacy of end-to-end and end-to-side nerve repair (neurorrhaphy) in the rat brachial plexus
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DOI：
10.1111/j.1469-7580.2009.01135.x
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发表时间：
2009-11-01
影响因子：
2.4
通讯作者：
Tseng, Guo-Fang
中科院分区：
文献类型：
--
作者：
Liao, Wen-Chieh;Chen, Jeng-Rung;Tseng, Guo-Fang
近端神经损伤通常需要神经转移来恢复功能。本研究旨在评价大鼠肌皮神经与尺神经端端吻合和端侧吻合的效果。供体端对端横切，同时暴露神经外膜窗进行端侧神经缝合。逆行追踪显示，70%的供体运动和感觉神经元在端端吻合后3个月长入受体，而端侧吻合后6个月为40-50%。在端对端神经缝合术中，再生的轴突表现为粗纤维，其直径在3-4个月内恢复到与对照组相当。然而，端侧神经缝合术诱导大多数细侧支的纤维缓慢发芽，到6个月时几乎没有接近控制直径。端对端缝合后4个月，运动终板恢复了控制密度，但端对侧神经缝合后6个月仍保持较低水平。短潜伏期复合肌肉动作电位，典型的控制，很容易恢复后端端神经缝合。端侧神经缝合术在4个月时具有低振幅和广泛的潜伏期，并且在6个月时未能恢复控制大小。梳理试验分别在端端和端侧神经缝合后3个月和6个月成功恢复，表明不需要强大的肌肉。简而言之，两种神经缝合都导致了功能恢复，但端对端神经缝合更快，更好，尽管以牺牲供体功能为代价。端侧神经吻合术辅以克服侧支发芽慢和运动恢复弱的因素可能值得进一步探索。
Proximal nerve injury often requires nerve transfer to restore function. Here we evaluated the efficacy of end-to-end and end-to-side neurorrhaphy of rat musculocutaneous nerve, the recipient, to ulnar nerve, the donor. The donor was transected for end-to-end, while an epineurial window was exposed for end-to-side neurorrhaphy. Retrograde tracing showed that 70% donor motor and sensory neurons grew into the recipient 3 months following end-to-end neurorrhaphy compared to 40-50% at 6 months following end-to-side neurorrhaphy. In end-to-end neurorrhaphy, regenerating axons appeared as thick fibers which regained diameters comparable to those of controls in 3-4 months. However, end-to-side neurorrhaphy induced slow sprouting fibers of mostly thin collaterals that barely approached control diameters by 6 months. The motor end plates regained their control density at 4 months following end-to-end but remained low 6 months following end-to-side neurorrhaphy. The short-latency compound muscle action potential, typical of that of control, was readily restored following end-to-end neurorrhaphy. End-to-side neurorrhaphy had low amplitude and wide-ranging latency at 4 months and failed to regain control sizes by 6 months. Grooming test recovered successfully at 3 and 6 months following end-to-end and end-to-side neurorrhaphy, respectively, suggesting that powerful muscle was not required. In short, both neurorrhaphies resulted in functional recovery but end-to-end neurorrhaphy was quicker and better, albeit at the expense of donor function. End-to-side neurorrhaphy supplemented with factors to overcome the slow collateral sprouting and weak motor recovery may warrant further exploration.