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

本实验研究证实了神经端侧吻合和旁路移植治疗周围神经损伤的有效性。我们采用周围神经完全性和不完全性撕裂伤模型。在大鼠坐骨神经完全撕裂伤模型中，完全切断坐骨神经，植入硅胶管不再生。在不完全性撕裂伤模型中，坐骨神经用6~0针缝合。在两种模型中，周围神经损伤区均由自体正中神经移植旁路移植。在完全性和不完全性撕裂伤模型中，对坐骨神经再生进行了电生理和组织学检查。BDA示踪检查分析再生轴突的位置。搭桥术部分或完全切断神经后6周可检测到M波。术后12周，不完全撕裂模型旁路移植组再生轴突约占70%，而完全撕裂模型组再生轴突约占50%，两者均表明再生轴突数量少于传统神经移植模型。神经细丝染色和BDA示踪检测显示神经轴突通过搭桥术再生。结论：神经端侧吻合的搭桥术是修复周围神经损伤的有效方法，尤其是对不完全性臂丛神经损伤等持续性神经损伤。

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.