Comparison of Results Following Nerve Repair Using Tubulization with or Without a Short Gap in Rabbit Radial Nerve Model

主要神经损伤通常难以适当地匹配和接合近端和远端纤维。更近端的病变由于纤维的混合而更加困难。近年来的研究表明，神经营养因子可诱导近端运动或感觉神经纤维再生到与之相匹配的特定终末器官，我们比较了兔正中神经管化和无小间隙的神经修复的结果。桡侧感觉神经和运动分支（骨间后神经）在其从干神经的分支部位使用。对侧桡神经作为对照。在A组中，感觉和运动支均被切断，并使用5 mm长的胶原进行接合。B组除将神经旋转180 °外，其余操作同A组。C组采用10 mm长的胶原管，在切口处留有5 mm的间隙 关于我们 接合部位。D组，采用10 mm长管，5 mm间隙，神经断端旋转180 °。术后24周，测量感觉支和运动支的神经传导速度、复合动作电位面积。在修复侧测定指总伸肌的收缩力和肌肉重量;随后立即对侧前肢进行相同的评价。神经传导速度和复合动作电位面积在各组间差异无统计学意义。B组肌肉力量（45.7%）明显低于其他各组。D组（97.7%）记录的肌肉力量与A组（93.6%）或C组（111.4%）相当。干肌肉重量与肌肉收缩力呈良好相关性，但组间无显著差异。神经纤维排列方向错误的神经接合无法实现充分的功能恢复。然而，如果在近端和远端神经残端之间提供闭合的小间隙，则未对齐的近端神经纤维可能通过亲神经因子的帮助检测到连接到匹配的靶器官的远端纤维。使用具有短间隙的可生物降解的惰性管进行神经修复可能是近端神经损伤的有用的临床适用方法。少

Major nerve injuries are often difficult to appropriately match and coapt proximal and distal fibers. More proximal lesions are even more difficult due to intermingling of the fibers. Recent investigations strongly suggests that neurotropic factor induces proximal motor or sensory nerve fibers to regenerate to the matched specific end organ.We compared the results following nerve repair using tubulization with or without a small gap in rabbit median nerve.Forty New Zealand white rabbits were divided into four groups. The radial sensory nerve and motor branch (posterior interosseous nerve) were used at their branching site from the trunk nerve. The contralateral radial nerve served as the control. In group A, both sensory and motor branches were severed and coapted using a 5-mm-long collagen. In group B, the same procedure was performed as Group A except nerves were rotated 180ﾟ. In Group C, the same procedure as Group A, but a 10-mm-long collagen tube was used and 5-mm gap left at the … More coaptation site. Group D, had 10-mm long tube, 5mm gap and nerve stumps rotated 180ﾟ, At 24 weeks postoperatively, nerve conduction velocities, compound action potential area were obtained from the both the sensory and motor branches. Contraction force and muscle weight of the extensor digitorum communis were determined on the repaired side ; this was followed immediately by identical evaluation on the contralateral forelimb. The results were expressed as the Percentage of normal control.Nerve conduction velocity and compound action potential area did not demonstrate statistically significant differences between groups. Muscle power of group B (45.7%) was significantly less than that of any other groups. Group D (97.7%) recorded comparable muscle power to that of group A (93.6%) or C(111.4%). Dry muscle weight demonstrated good correlation with the muscle contraction force, however, there was no significant difference between groups.Nerve coaptation with misdirected nerve fiber alignment does not allow sufficient functional recovery. If a closed, small gap between the proximal and distal nerve stumps is provided, however, misaligned proximal nerve fiber may detect a distal fiber connecting to the matched target organ probably by the aid of neurotropic factors. Nerve repair using biodegradable, inert tubing with a short gap may be a useful, clinically applicable method in proximal nerve injury. Less