End-to side neurorrhaphy and bypass graft for peripheral injury: an experimental study and its clinical application

本实验研究表明神经端侧吻合和旁路移植对周围神经损伤的治疗是有效的。并指出其临床应用。我们采用周围神经完全裂伤模型和不完全裂伤模型。在完全撕裂伤模型中，将大鼠坐骨神经完全切开，插入硅管不再生。在不完全撕裂伤模型中，以6-0针收紧坐骨神经。在两种模型中，周围神经损伤区均采用自体正中神经旁路移植。在完全裂伤模型和不完全裂伤模型中对坐骨神经的再生进行了电图和组织学检查。同时进行BDA示踪检查，分析再生轴突的位置。在搭桥神经部分和完全撕裂后6周检测m波。术后12周，不完全裂伤搭桥模型的轴突再生率约为70%，完全裂伤模型的轴突再生率约为50%，两者均表明与常规神经移植模型相比，轴突再生数量较少。神经丝染色和BDA微量检查显示经旁路移植的轴突再生。综上所述，神经端侧吻合旁路移植术是修复周围神经缺损的有效方法，尤其适用于连续性神经损伤，如臂丛神经不完全性损伤。

This experimental study demonstrates usefulness of end-to-side neurorrhaphy and bypass graft for the peripheral nerve injury. Its clinical application is also indicated.We used the complete and incomplete laceration models of the peripheral nerve. In the complete laceration model, the rat's sciatic nerve was completely sectioned and the silicon tube was inserted not to regenerate. In the incomplete laceration model, the sciatic nerve was tightened up with 6-0 stitches. In the both model, damaged area of the peripheral nerve was bypass grafted by the autografted median nerve. Regeneration of the sciatic nerve was examined electomyographically and histologically in the complete and incomplete laceration models. BDA trace examination was also performed to analyze where the regenerative axon located.M-wave was detected in 6 weeks after partial and complete laceration of the nerve with the bypass graft. Approximately 70% regeneration axons was noted in the bypass graft of incomplete laceration model 12 weeks after the surgery, while approximately 50% regeneration axons was found in complete laceration model, both of which indicated smaller number of regeneration of the axons in comparison with the conventional nerve graft model. Neurofilament staining and BDA trace examination indicated regenerative axons via the bypass graft.In conclusion, the bypass graft using the end-to-side neurorrhaphy is useful method for augmentation of the damaged peripheral nerve, especially in continuous nerve damage, such as the incomplete brachial plexus injury.