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

本实验研究证实了端侧吻合和旁路移植在周围神经损伤中的有效性。我们采用了周围神经完全性和不完全性损伤模型。在完全性坐骨神经损伤模型中，将大鼠坐骨神经完全切断，并插入硅胶管不再生。在不完全撕裂模型中，用6-0针收紧坐骨神经。两种模型均采用自体正中神经移植于周围神经缺损区。在完全和不完全撕裂模型中，对坐骨神经再生进行肌电图和组织学检查。用BDA示踪法分析再生轴突的位置，并在部分和完全神经切断后6周检测M波。术后12周，不完全性撕裂模型的旁路移植物中约有70%的再生轴突，而完全性撕裂模型中约有50%的再生轴突，这两种模型的再生轴突数量均低于传统的神经移植物模型。神经丝染色和BDA示踪显示有再生轴突通过旁路移植物再生。结论：端侧吻合的旁路移植物是修复周围神经损伤的有效方法，尤其适用于连续性神经损伤，如不完全性臂丛神经损伤。

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.