小间隙神经吻合方法的实验研究
|
摘要
目的通过动物实验,比较神经外膜直接吻合法、神经外膜小间隙吻合法和血管间隙神经吻合法等三种神经吻合方法的优劣,为临床应用做参考。
方法雌性SD大白鼠72只,随机分为三个,即神经外膜直接吻合法组(对照组)、神经外膜袖套吻合法组(实验组A)和血管间隙神经吻合法组(实验组B),每组24只。各组均取左侧卧位,以右侧为实验侧,解剖出大腿中段坐骨神经,横行切断,其中对照组对离断的神经直接吻合；实验组A翻起两断端神经外膜,分别牵出并剪除约1mm神经纤维,然后把神经外膜翻回并用11-0显微缝线吻合,使置留约2mm外膜间隙；实验组B切断神经同时切取股静脉4mm,将两神经断端各套入静脉血管管腔内1mm,留2mm的间隙于两神经断端之间,用11-0显微缝线固定静脉血管两端于神经外膜之上,各组术后缝皮、取回饲养。术后2、4、8周分别取上述各组大鼠8只,检测吻合口形态(显微镜下)、腓肠肌最大收缩力、腓肠肌肌肉湿重、坐骨神经有髓纤维计数、电镜观察超微结构以及组织学观察等指标,做出统计学分析。
结果对照组,术后2周,吻合口与周围组织粘连较重,疤痕组织增生,神经瘤未明显形成,随时间进展,术后4、8周时,吻合口处粘连减轻,疤痕组织逐渐减少,有神经瘤形成；实验组A术后各观察时间段吻合口处未见与周围组织明显粘连,疤痕组织增生逐渐加重,无神经瘤形成,常可见神经吻合口近远端膨大,外膜袖套处变细；实验组B各观察时间段吻合口处未见与周围组织明显粘连,静脉桥外可见一定的疤痕组织增生,亦常可见桥接之静脉管套处变细。各组腓肠肌肌湿重在术后观察的各时间段差异不显著(p>0.05)。术后2、4周,各组腓肠肌“最大强直收缩力”的恢复无差异(p>0.05)；术后8周,对照组与实验组A腓肠肌“最大强直收缩力”的恢复无显著差异(p>0.05),均优于实验组B(p<0.05)。术后2周,各组有髓神经纤维广泛坏死,罕见新生有髓神经纤维形成；术后4周,各组有髓神经纤维总数中对照组和实验组A组无显著差异(p>0.05),均优于实验组B(p<0.05)；术后8周,各组有髓神经纤维较前都有恢复,且总恢复程度无显著差异(p>0.05)。电镜观察,术后2周,各组有髓神经纤维以凋亡为主,少见新生髓鞘形成；术后4周,各组有髓神经纤维凋亡与新生共存,以新生为主,神经纤维直径较小,排列紊乱,形态也不甚规则,神经髓鞘亦较薄,各组新生有髓神经纤维大小和髓鞘厚度未见显著差异(p>0.05)；术后8周,各组有髓神经纤维以新生为主,凋亡现象已少见,有髓神经纤维分布已显规则,直径较前增大,形态规则,髓鞘厚度增大,层次感较前清晰,各组新生有髓神经纤维大小和髓鞘厚度未见显著差异(p>0.05)。组织学观察,对照组术后2周,见吻合口外结缔组织增生,内含丰富的血管形成,吻合口内有髓神经纤维凋亡,髓鞘溶解、崩裂,轴突消失,组织走行紊乱,且有暂留神经纤维向吻合口外膨出之现象,未见连续有髓神经纤维通过吻合口,术后4周,有髓神经纤维凋亡现象已经明显减少,新生有髓纤维形成,并连续性通过吻合衔接处,其中部分新生纤维通过外膜吻合口向外膨出,术后8周,吻合口处和神经远端的中央有部分疤痕组织增生,与新生的连续性有髓神经纤维交叉伴行,有髓神经纤维总数较前明显增加,神经外膜以外有结缔组织增生,使得神经周径变大,神经外膜通常已消失不见,转而由溢出的神经纤维和增生的结缔组织形成神经瘤包绕；实验组A,术后2周,吻合口处神经外膜内壁少量结缔组织生成,神经内部形成中空管腔,连续、整齐的有髓神经纤维从吻合口近端沿管腔生长,但是尚未达到离断远端的神经束,术后4周,吻合口处神经外膜内壁的疤痕组织增生较前明显、变厚,疤痕围成的内部管腔已经充满由近端生长而来的有髓神经纤维,术后8周,吻合口神经外膜处的疤痕组织较前增厚,并且疤痕内部有新生血管形成,疤痕管腔内的有髓神经纤维密度较前明显增加,排列紧密、规则；实验组B,术后2周,桥接静脉管壁内有疤痕组织形成,管壁亦疤痕化,有时可见静脉近远端两侧吻合口处广泛疤痕增生,妨碍或者阻止神经纤维通过,术后4周,静脉管壁附近的疤痕组织亦较明显,管壁已经模糊不可辨认,管腔内部的有髓神经纤维较前明显增多,与散在的疤痕组织交错绕行,术后8周,吻合口外周的的疤痕组织较前增厚,并且疤痕内部有新生血管形成,疤痕管腔内的有髓神经纤维密度较前明显增加。
结论神经外膜直接吻合法比神经外膜袖套吻合法、血管间隙神经吻合法优越。
Objectives Through animal experiment, comparing direct epineurial anastomosis method, epineurial small gap anastomosis method, and vascular nerve anastomosis method, pros and cons of three nerve anastomosis methods, as a reference for clinical application.
Method 72 female SD rats, randomly divided into 3 experiment groups, that is direct epineurial anastomosis method group (control group), epineurial small gap anastomosis method group (experiment group A), and vascular nerve anastomosis method group (experiment group B), each group had 24 rats. Every rats of each group were done in lateral position, anatomically the experimental side was mid-thigh sciatic Nerve, transverse cut, which is in control group the broken nerve was sutured directly; in experiment group A reveal two epineurial stump, pull out and cut off the nerve fibers about 1 mm, then used 11-0 microsurgery suture at 2 mm from outer space; in experiment group B cut off the nerve and at the same time took out 4 mm of femoral vein, then put the two sets of nerve stump 1 mm inside the vein tube cavity,left 2 mm gaps between two side, used 11-0 microsurgery sutures fixed the vein on both ends of the nerve membrane; post-op, the skin of each group's rats were sutured and they were feeding. At 2,4,8 weeks post-op, took out 8 rats from each groups as mentioned above, examined the anastomotic pattern (under microscope), gastrocnemius' biggest contracture, gastrocnemius muscle wet weight, Myelinated fiber counts of sciatic nerve, SEM observation of ultrastructure as well as histological observation as indicators, made a statistical analysis.
Results control group,2 weeks post-op, the adhesion between the anastomosis site and the surrounding tissue was severer, scar tissue proliferates, neuroma formation was not obvious, progress over time.4 and 8 weeks post-op, the anastomosis' adhesion was milder, scar tissue proliferation lesser, there was neuroma formation; Experiment group A, in all observation time, no obvious adhesion formation can be seen, scar tissue proliferation become severer, no neuroma formation, often can be seen swollen at the distal and proximal of anastomosis site, outer layer become thinner; Experiment group B, in all observation time, no obvious adhesion formation can be seen, a certain degree of scar tissue proliferation can be seen around the venous bridge,the tube that connected the vein and the nerve is usually become thinner. The wet weight of the gastrocnemius muscle of each group has no significant differences (p> 0.05). Post-op 2 and 4 Weeks, The maximum tetanic contraction of each group's gastrocnemius muscle has no significant recovery (p> 0.05); Post-op 8 weeks, both control group and experiment group I's grastrocnemius muscle maximum tetanic contraction has no significant recovery (p> 0.05), on average it is better from experiment group B (p< 0.05).2 weeks post-op,each group has extensive necrosis of myelinated nerve fibers,it's very rare to find a new myelinated nerve fibers formation.4 weeks post-op, From total myelinated nerve fibers of each group, there is no significant difference between the total number in control group and experiment group A (p> 0.05), but they are better than experiment group B (p< 0.05); 8 weeks post-op,most of each group's myelinated nerve fibers have restored compare to earlier time,and no significant difference from the degree of restoration (p> 0.05).
Under SEM observation, post-op 2 weeks, each group showed mainly the damaged myelinated nerve fibers,rare in the formation of new myelin; post-op 4 weeks,each group has new and damaged myelinated nerve fibers which is the new ones mainly seen,the nerve fibers' diameter are smaller, disarrangement, morphology is also irregular,nerve myelin is also thinner, each group showed no significant difference at the new myelinated nerve fibers'size and the myelin sheath thickness (p> 0.05); post-op 8 weeks, each group showed mostly the new myelinated nerve fibers, the damaged ones become lesser, the myelinated nerve fibers' distribution is regular at this point, the diameter is bigger than before, morphology is regular, the myelin sheath thickness has increased,the layers are clearer than before, There is no significant differences between the new myelinated nerve fibers size and myelin sheath thickness of each group (p > 0.05). Histology observation, control group post-op 2 weeks,outside the anastomosis site can see connective tissue hyperplasia,contains rich of blood vessels formation,within the anastomosis site can see the damaged myelinated nerve afibers,myelinolysis,crack,axons disappeared, tissues disorder,and there is some swollen myelinated nerve at the anastomosis site,can not see any myelinated nerve fibers pass through the anastomosis site. post-op 4 weeks, the damaged myelinated nerve fibers decrease dramatically, new myelin fibers formation, and also pass through the anastomosis site, Some of new fibers protruding outward through the outer membrane of anastomosis. Post-op 8 weeks,the central part of the distal anastomosis site shows scar tissue formation,accompanied by the new myelinated nerve fibers, the total of the myelinated nerve fibers formed has increased, Epineurial connective tissue proliferation, makes the nerve circumference larger, epineurial usually disappear, In turn by the overflow of nerve fibers and hyperplasia of connective tissue surrounding the formation of neuroma; Experimental group A, post-op 2 weeks, Inner side of epineurial anastomosis generates a small amount of connective tissue, the hollow formation inside the nerve lumen, continuation, the nerve myelinated fibers grow neatly along the lumen, but has not reached the distal part of the nerve bundle, post-op 4 weeks, scar tissue at the anastomosis site wall become more prominent, thicker, Scar surrounded the internal cavity has been filled with the growth came from the proximal myelinated nerve fibers, post-op 8 weeks, scar tissue at the anastomosis site wall become thicker than before, within the scar there is new blood vessels formation, the density of the myelinated nerve fibers within the scar lumen increased, arranged closely, regularly. Experiment group B, post-op 2 weeks, scar tissue formation within the wall of the venous bridge, scarring of the wall as well, a broad scar hyperplasia sometimes can be seen near distal venous anastomosis on both sides, impede or blockade the nerve fibers passing through, post-op 4 weeks, the vicinity of the scar tissue inside the wall is become more apparent, the wall is blurred can not been identified, the myelinated nerve fibers within the lumen increased compare to before, and the scattered scar tissue staggered bypass, post-op 8 weeks, scartissue outside the anastomosis site is thicker, and new blood vessels formation inside the scar, the density of the myelinated nerve fibers within the scar lumen increased than before.
Conclusion The traditional direct repairment method is better than vascular nerve anastomosis method and epineurial small gap anastomosis method.
方法雌性SD大白鼠72只,随机分为三个,即神经外膜直接吻合法组(对照组)、神经外膜袖套吻合法组(实验组A)和血管间隙神经吻合法组(实验组B),每组24只。各组均取左侧卧位,以右侧为实验侧,解剖出大腿中段坐骨神经,横行切断,其中对照组对离断的神经直接吻合；实验组A翻起两断端神经外膜,分别牵出并剪除约1mm神经纤维,然后把神经外膜翻回并用11-0显微缝线吻合,使置留约2mm外膜间隙；实验组B切断神经同时切取股静脉4mm,将两神经断端各套入静脉血管管腔内1mm,留2mm的间隙于两神经断端之间,用11-0显微缝线固定静脉血管两端于神经外膜之上,各组术后缝皮、取回饲养。术后2、4、8周分别取上述各组大鼠8只,检测吻合口形态(显微镜下)、腓肠肌最大收缩力、腓肠肌肌肉湿重、坐骨神经有髓纤维计数、电镜观察超微结构以及组织学观察等指标,做出统计学分析。
结果对照组,术后2周,吻合口与周围组织粘连较重,疤痕组织增生,神经瘤未明显形成,随时间进展,术后4、8周时,吻合口处粘连减轻,疤痕组织逐渐减少,有神经瘤形成；实验组A术后各观察时间段吻合口处未见与周围组织明显粘连,疤痕组织增生逐渐加重,无神经瘤形成,常可见神经吻合口近远端膨大,外膜袖套处变细；实验组B各观察时间段吻合口处未见与周围组织明显粘连,静脉桥外可见一定的疤痕组织增生,亦常可见桥接之静脉管套处变细。各组腓肠肌肌湿重在术后观察的各时间段差异不显著(p>0.05)。术后2、4周,各组腓肠肌“最大强直收缩力”的恢复无差异(p>0.05)；术后8周,对照组与实验组A腓肠肌“最大强直收缩力”的恢复无显著差异(p>0.05),均优于实验组B(p<0.05)。术后2周,各组有髓神经纤维广泛坏死,罕见新生有髓神经纤维形成；术后4周,各组有髓神经纤维总数中对照组和实验组A组无显著差异(p>0.05),均优于实验组B(p<0.05)；术后8周,各组有髓神经纤维较前都有恢复,且总恢复程度无显著差异(p>0.05)。电镜观察,术后2周,各组有髓神经纤维以凋亡为主,少见新生髓鞘形成；术后4周,各组有髓神经纤维凋亡与新生共存,以新生为主,神经纤维直径较小,排列紊乱,形态也不甚规则,神经髓鞘亦较薄,各组新生有髓神经纤维大小和髓鞘厚度未见显著差异(p>0.05)；术后8周,各组有髓神经纤维以新生为主,凋亡现象已少见,有髓神经纤维分布已显规则,直径较前增大,形态规则,髓鞘厚度增大,层次感较前清晰,各组新生有髓神经纤维大小和髓鞘厚度未见显著差异(p>0.05)。组织学观察,对照组术后2周,见吻合口外结缔组织增生,内含丰富的血管形成,吻合口内有髓神经纤维凋亡,髓鞘溶解、崩裂,轴突消失,组织走行紊乱,且有暂留神经纤维向吻合口外膨出之现象,未见连续有髓神经纤维通过吻合口,术后4周,有髓神经纤维凋亡现象已经明显减少,新生有髓纤维形成,并连续性通过吻合衔接处,其中部分新生纤维通过外膜吻合口向外膨出,术后8周,吻合口处和神经远端的中央有部分疤痕组织增生,与新生的连续性有髓神经纤维交叉伴行,有髓神经纤维总数较前明显增加,神经外膜以外有结缔组织增生,使得神经周径变大,神经外膜通常已消失不见,转而由溢出的神经纤维和增生的结缔组织形成神经瘤包绕；实验组A,术后2周,吻合口处神经外膜内壁少量结缔组织生成,神经内部形成中空管腔,连续、整齐的有髓神经纤维从吻合口近端沿管腔生长,但是尚未达到离断远端的神经束,术后4周,吻合口处神经外膜内壁的疤痕组织增生较前明显、变厚,疤痕围成的内部管腔已经充满由近端生长而来的有髓神经纤维,术后8周,吻合口神经外膜处的疤痕组织较前增厚,并且疤痕内部有新生血管形成,疤痕管腔内的有髓神经纤维密度较前明显增加,排列紧密、规则；实验组B,术后2周,桥接静脉管壁内有疤痕组织形成,管壁亦疤痕化,有时可见静脉近远端两侧吻合口处广泛疤痕增生,妨碍或者阻止神经纤维通过,术后4周,静脉管壁附近的疤痕组织亦较明显,管壁已经模糊不可辨认,管腔内部的有髓神经纤维较前明显增多,与散在的疤痕组织交错绕行,术后8周,吻合口外周的的疤痕组织较前增厚,并且疤痕内部有新生血管形成,疤痕管腔内的有髓神经纤维密度较前明显增加。
结论神经外膜直接吻合法比神经外膜袖套吻合法、血管间隙神经吻合法优越。
Objectives Through animal experiment, comparing direct epineurial anastomosis method, epineurial small gap anastomosis method, and vascular nerve anastomosis method, pros and cons of three nerve anastomosis methods, as a reference for clinical application.
Method 72 female SD rats, randomly divided into 3 experiment groups, that is direct epineurial anastomosis method group (control group), epineurial small gap anastomosis method group (experiment group A), and vascular nerve anastomosis method group (experiment group B), each group had 24 rats. Every rats of each group were done in lateral position, anatomically the experimental side was mid-thigh sciatic Nerve, transverse cut, which is in control group the broken nerve was sutured directly; in experiment group A reveal two epineurial stump, pull out and cut off the nerve fibers about 1 mm, then used 11-0 microsurgery suture at 2 mm from outer space; in experiment group B cut off the nerve and at the same time took out 4 mm of femoral vein, then put the two sets of nerve stump 1 mm inside the vein tube cavity,left 2 mm gaps between two side, used 11-0 microsurgery sutures fixed the vein on both ends of the nerve membrane; post-op, the skin of each group's rats were sutured and they were feeding. At 2,4,8 weeks post-op, took out 8 rats from each groups as mentioned above, examined the anastomotic pattern (under microscope), gastrocnemius' biggest contracture, gastrocnemius muscle wet weight, Myelinated fiber counts of sciatic nerve, SEM observation of ultrastructure as well as histological observation as indicators, made a statistical analysis.
Results control group,2 weeks post-op, the adhesion between the anastomosis site and the surrounding tissue was severer, scar tissue proliferates, neuroma formation was not obvious, progress over time.4 and 8 weeks post-op, the anastomosis' adhesion was milder, scar tissue proliferation lesser, there was neuroma formation; Experiment group A, in all observation time, no obvious adhesion formation can be seen, scar tissue proliferation become severer, no neuroma formation, often can be seen swollen at the distal and proximal of anastomosis site, outer layer become thinner; Experiment group B, in all observation time, no obvious adhesion formation can be seen, a certain degree of scar tissue proliferation can be seen around the venous bridge,the tube that connected the vein and the nerve is usually become thinner. The wet weight of the gastrocnemius muscle of each group has no significant differences (p> 0.05). Post-op 2 and 4 Weeks, The maximum tetanic contraction of each group's gastrocnemius muscle has no significant recovery (p> 0.05); Post-op 8 weeks, both control group and experiment group I's grastrocnemius muscle maximum tetanic contraction has no significant recovery (p> 0.05), on average it is better from experiment group B (p< 0.05).2 weeks post-op,each group has extensive necrosis of myelinated nerve fibers,it's very rare to find a new myelinated nerve fibers formation.4 weeks post-op, From total myelinated nerve fibers of each group, there is no significant difference between the total number in control group and experiment group A (p> 0.05), but they are better than experiment group B (p< 0.05); 8 weeks post-op,most of each group's myelinated nerve fibers have restored compare to earlier time,and no significant difference from the degree of restoration (p> 0.05).
Under SEM observation, post-op 2 weeks, each group showed mainly the damaged myelinated nerve fibers,rare in the formation of new myelin; post-op 4 weeks,each group has new and damaged myelinated nerve fibers which is the new ones mainly seen,the nerve fibers' diameter are smaller, disarrangement, morphology is also irregular,nerve myelin is also thinner, each group showed no significant difference at the new myelinated nerve fibers'size and the myelin sheath thickness (p> 0.05); post-op 8 weeks, each group showed mostly the new myelinated nerve fibers, the damaged ones become lesser, the myelinated nerve fibers' distribution is regular at this point, the diameter is bigger than before, morphology is regular, the myelin sheath thickness has increased,the layers are clearer than before, There is no significant differences between the new myelinated nerve fibers size and myelin sheath thickness of each group (p > 0.05). Histology observation, control group post-op 2 weeks,outside the anastomosis site can see connective tissue hyperplasia,contains rich of blood vessels formation,within the anastomosis site can see the damaged myelinated nerve afibers,myelinolysis,crack,axons disappeared, tissues disorder,and there is some swollen myelinated nerve at the anastomosis site,can not see any myelinated nerve fibers pass through the anastomosis site. post-op 4 weeks, the damaged myelinated nerve fibers decrease dramatically, new myelin fibers formation, and also pass through the anastomosis site, Some of new fibers protruding outward through the outer membrane of anastomosis. Post-op 8 weeks,the central part of the distal anastomosis site shows scar tissue formation,accompanied by the new myelinated nerve fibers, the total of the myelinated nerve fibers formed has increased, Epineurial connective tissue proliferation, makes the nerve circumference larger, epineurial usually disappear, In turn by the overflow of nerve fibers and hyperplasia of connective tissue surrounding the formation of neuroma; Experimental group A, post-op 2 weeks, Inner side of epineurial anastomosis generates a small amount of connective tissue, the hollow formation inside the nerve lumen, continuation, the nerve myelinated fibers grow neatly along the lumen, but has not reached the distal part of the nerve bundle, post-op 4 weeks, scar tissue at the anastomosis site wall become more prominent, thicker, Scar surrounded the internal cavity has been filled with the growth came from the proximal myelinated nerve fibers, post-op 8 weeks, scar tissue at the anastomosis site wall become thicker than before, within the scar there is new blood vessels formation, the density of the myelinated nerve fibers within the scar lumen increased, arranged closely, regularly. Experiment group B, post-op 2 weeks, scar tissue formation within the wall of the venous bridge, scarring of the wall as well, a broad scar hyperplasia sometimes can be seen near distal venous anastomosis on both sides, impede or blockade the nerve fibers passing through, post-op 4 weeks, the vicinity of the scar tissue inside the wall is become more apparent, the wall is blurred can not been identified, the myelinated nerve fibers within the lumen increased compare to before, and the scattered scar tissue staggered bypass, post-op 8 weeks, scartissue outside the anastomosis site is thicker, and new blood vessels formation inside the scar, the density of the myelinated nerve fibers within the scar lumen increased than before.
Conclusion The traditional direct repairment method is better than vascular nerve anastomosis method and epineurial small gap anastomosis method.
引文
[1]冯宪发.周围神经外膜吻合方法的改进性临床研究.实用手外科杂志.2007.12,21(4)：195-197.
[2]黄启云.硅胶管套接法治疗陈旧性周围神经损伤.中国骨伤.2003.10,16(10)：630
[3]江长青,万圣祥.周围神经生物活性管桥的制备和应用研究.实用手外科杂志.2008,22(4)：19.
[4]王勤瑛,华清泉,汪审清.纤维蛋白胶在几丁质管修复面神经缺损中的应用.生物医学工程学杂志.2007.24(3)：612-614.
[5]黑发志.神经外膜袖套式吻合修复神经断伤.吉林医学.2008.11.2,9(21)：1865-1866.
[6]袁炜庆,等.小间隙外膜袖缝合法的临床疗效观察.微创医学.2008,3(6)：593-594.
[7]尹维田.小间隙桥接法和神经外膜吻合法修复周围神经断裂的实验研究.吉林大学学报(医学版).2005.11,31(6)：869-871.
[8]姜保国,王澍寰,等.围周神经小间隙动脉套桥接与外膜缝合研究比较.北京医科大学学报.1994,26(4)：249-250.
[9]宋修竹,顾玉东,等.不同对位情况下神经直接缝合与小间隙套管法修复的疗效比较.中华手外科杂志.1998.12,14(4)：250-251.
[10]蔡有根,桂平.硅胶管内神经套接术治疗周围围神经缺损．江西医药.2003,39(6)：407-408.
[11]杨绍安,舒小秋,刘宁富.小间隙外膜袖缝合修复外周神经损伤.中华显微外科杂志.2003.2,26(1)：63-64.
[12]Buti M,Verdu E,Labrador RO,et al.Influence of physical parameters of nerve chambers on peripheral nerve regeneration and reinnervation. ExpNeuro,1996,137:26-33.
[13]冯宪发,于惊涛,等.神经再生室与微环境研究的新模型.实用手外科杂志.2001.12,15(4)：222-223.
[1]杨绍安,舒小秋,刘宁富.小间隙外膜袖缝合修复外周神经损伤.中华显微外科杂志.2003.2,2(1)：63-64.
[2]宋修竹,顾玉东,胡韶楠.神经再生室中神经再生过程和微环境的研究[J].中华手外科杂志.2001,17(1)：39.
[3]赵立国,姚康德.神经导管修复周围神经损伤的研究进展[J].生物医学工程与临床.2003,7(2)：120-123.
[4]姜保国,李剑.替代神经外膜缝合—小间隙套接法修复周围神经损伤[J].中国矫形外科杂志.2003,11(8)：544-546.
[5]杨绍安,刘宁富,肖晓桃.小间隙外膜袖缝合治疗周围神经损30例[J].中国临床康复杂志.2003,7(26)：3645-3646.
[6]尹维田.小间隙桥接法和神经外膜吻合法修复周围神经断裂的实验研究.吉林大学学报(医学版).2005.11,31(6)：869-871.
[7]冯宪发.周围神经外膜吻合方法的改进性临床研究.实用手外科杂志.2007.12,21(4)：195-197.
[8][Lundborg G. Nerve regeneration and repair. A review. Acta Or-thop Scand, 1987,58(2):145-147.
[9]宋修竹,顾玉东.不同对位情况下神经直接缝合与小间隙套管法修复的疗效比较.中华手外科杂志.1998.12,14(4)：250-251.
[10]黄启云.硅胶管套接法治疗陈旧性周围神经损伤.中国骨伤.2003.10,16(10)：630.
[11]罗智捷,卢世壁.神经套接后混合神经中再生的运动和感觉纤维选择性重新支配靶器官.中华外科杂志.1996,34(1)：44-46.
[12]程赛宇.几丁质在大鼠坐骨神经损伤早期修复作用的研究.第三军医大学学报.2002.9,24(9)：1017-1019.
[13]Haipeng G, Yinghui Z, Jianchun L, et al. Studies on nerve cell affinity of chitosan-derived materials [J].J Biomed Mater Res,2000,52(2):285-295.
[14]Hirano S, Tanaka Y, Hasegawa M, et al. Effect of sulfated derivatives of chitosan on some blood coagulant factors [J]. Carbohydr Res,1985,137: 205-215.
[15]江长青,万圣祥.周围神经生物活性管桥的制备和应用研究.实用手外科杂志.2008,22(4)：19.
[16]杨绍安,舒小秋,刘宁富.小间隙外膜袖缝合修复外周神经损伤.中华显微外科杂志.2003.2,26(1)：63-64.
[17]姜保国,王澍寰,冯传汉.周围神经小间隙动脉套桥接与外膜缝合比较研究.北京医科大学学报.1994,26(4)：249-250.
[18]苟三杯,侯春林.几丁质室内植入雪旺细胞对神经再生影响实验研究.中华修复重建外科杂志.1995,9：109.
[19]王平,等.含神经生长因子的羊膜基质管桥接修复神经缺损的实验研究.中华显微外科杂志.2001.2,21(1)：42-45.
[20]于炎冰,等.含神经生长因子的壳聚糖导管桥接周围神经缺损的实验研究.中华神经外科疾病研究杂志.2003,2(3)：228-231.
[21]吕德成,等.利用神经再生室观察FK506促进神经再生的实验研究.中 华医学杂志.2005.7.27,85(28)：1978-1981.
[22]李坚,等.神经再生室桥接断离面神经的实验研究.中国临床康复.2002.6,6(12)：1748-1749.
[23]Chen YS,Hsieh CL,Tsai CC,et al. Peripheral nerve regeneration using silicone rubber chambers filled with collagen, laminin and fibronectin[J]. Biomaterials,2000,21(15):1541-1547.
[24]袁炜庆,等.小间隙外膜袖缝合法的临床疗效观察.微创医学.2008,3(6)：593-594.
[25]胡勇,等.甲壳胺膜管修复不同长度神经缺损的实验研究.中国临床康复.2004.5,8(13)：2564-2565.
[26]Young RC,Wiberg M,Terenghi G.. Poly-3-hydroxybutyrate (PHB):a resorbable conduit for long-gap repair in peripheral nerves[J]. Br J PlastSurg,2002,55 (3):235-240.
[27]Matsumoto K,Ohnishi K,Kiyotani T,et al. Peripheral nerve regeneration across an 80-mm gap bridged by a polyglycolic acid (PGA)-collagen tube filled with laminin-coated collagen fibers:a histological and electrophysiological evaluation of regenerated nerves [J]. Brain Res,2000,868(2):315-328.
[28]Matsumoto K,Ohnishi K,Sekine T,et al. Use of a newly developed artificial nerve conduit to assist peripheral nerve regeneration across a long gap in dogs [J]. ASAIO J,2000,46(4):415-420.
[2]黄启云.硅胶管套接法治疗陈旧性周围神经损伤.中国骨伤.2003.10,16(10)：630
[3]江长青,万圣祥.周围神经生物活性管桥的制备和应用研究.实用手外科杂志.2008,22(4)：19.
[4]王勤瑛,华清泉,汪审清.纤维蛋白胶在几丁质管修复面神经缺损中的应用.生物医学工程学杂志.2007.24(3)：612-614.
[5]黑发志.神经外膜袖套式吻合修复神经断伤.吉林医学.2008.11.2,9(21)：1865-1866.
[6]袁炜庆,等.小间隙外膜袖缝合法的临床疗效观察.微创医学.2008,3(6)：593-594.
[7]尹维田.小间隙桥接法和神经外膜吻合法修复周围神经断裂的实验研究.吉林大学学报(医学版).2005.11,31(6)：869-871.
[8]姜保国,王澍寰,等.围周神经小间隙动脉套桥接与外膜缝合研究比较.北京医科大学学报.1994,26(4)：249-250.
[9]宋修竹,顾玉东,等.不同对位情况下神经直接缝合与小间隙套管法修复的疗效比较.中华手外科杂志.1998.12,14(4)：250-251.
[10]蔡有根,桂平.硅胶管内神经套接术治疗周围围神经缺损．江西医药.2003,39(6)：407-408.
[11]杨绍安,舒小秋,刘宁富.小间隙外膜袖缝合修复外周神经损伤.中华显微外科杂志.2003.2,26(1)：63-64.
[12]Buti M,Verdu E,Labrador RO,et al.Influence of physical parameters of nerve chambers on peripheral nerve regeneration and reinnervation. ExpNeuro,1996,137:26-33.
[13]冯宪发,于惊涛,等.神经再生室与微环境研究的新模型.实用手外科杂志.2001.12,15(4)：222-223.
[1]杨绍安,舒小秋,刘宁富.小间隙外膜袖缝合修复外周神经损伤.中华显微外科杂志.2003.2,2(1)：63-64.
[2]宋修竹,顾玉东,胡韶楠.神经再生室中神经再生过程和微环境的研究[J].中华手外科杂志.2001,17(1)：39.
[3]赵立国,姚康德.神经导管修复周围神经损伤的研究进展[J].生物医学工程与临床.2003,7(2)：120-123.
[4]姜保国,李剑.替代神经外膜缝合—小间隙套接法修复周围神经损伤[J].中国矫形外科杂志.2003,11(8)：544-546.
[5]杨绍安,刘宁富,肖晓桃.小间隙外膜袖缝合治疗周围神经损30例[J].中国临床康复杂志.2003,7(26)：3645-3646.
[6]尹维田.小间隙桥接法和神经外膜吻合法修复周围神经断裂的实验研究.吉林大学学报(医学版).2005.11,31(6)：869-871.
[7]冯宪发.周围神经外膜吻合方法的改进性临床研究.实用手外科杂志.2007.12,21(4)：195-197.
[8][Lundborg G. Nerve regeneration and repair. A review. Acta Or-thop Scand, 1987,58(2):145-147.
[9]宋修竹,顾玉东.不同对位情况下神经直接缝合与小间隙套管法修复的疗效比较.中华手外科杂志.1998.12,14(4)：250-251.
[10]黄启云.硅胶管套接法治疗陈旧性周围神经损伤.中国骨伤.2003.10,16(10)：630.
[11]罗智捷,卢世壁.神经套接后混合神经中再生的运动和感觉纤维选择性重新支配靶器官.中华外科杂志.1996,34(1)：44-46.
[12]程赛宇.几丁质在大鼠坐骨神经损伤早期修复作用的研究.第三军医大学学报.2002.9,24(9)：1017-1019.
[13]Haipeng G, Yinghui Z, Jianchun L, et al. Studies on nerve cell affinity of chitosan-derived materials [J].J Biomed Mater Res,2000,52(2):285-295.
[14]Hirano S, Tanaka Y, Hasegawa M, et al. Effect of sulfated derivatives of chitosan on some blood coagulant factors [J]. Carbohydr Res,1985,137: 205-215.
[15]江长青,万圣祥.周围神经生物活性管桥的制备和应用研究.实用手外科杂志.2008,22(4)：19.
[16]杨绍安,舒小秋,刘宁富.小间隙外膜袖缝合修复外周神经损伤.中华显微外科杂志.2003.2,26(1)：63-64.
[17]姜保国,王澍寰,冯传汉.周围神经小间隙动脉套桥接与外膜缝合比较研究.北京医科大学学报.1994,26(4)：249-250.
[18]苟三杯,侯春林.几丁质室内植入雪旺细胞对神经再生影响实验研究.中华修复重建外科杂志.1995,9：109.
[19]王平,等.含神经生长因子的羊膜基质管桥接修复神经缺损的实验研究.中华显微外科杂志.2001.2,21(1)：42-45.
[20]于炎冰,等.含神经生长因子的壳聚糖导管桥接周围神经缺损的实验研究.中华神经外科疾病研究杂志.2003,2(3)：228-231.
[21]吕德成,等.利用神经再生室观察FK506促进神经再生的实验研究.中 华医学杂志.2005.7.27,85(28)：1978-1981.
[22]李坚,等.神经再生室桥接断离面神经的实验研究.中国临床康复.2002.6,6(12)：1748-1749.
[23]Chen YS,Hsieh CL,Tsai CC,et al. Peripheral nerve regeneration using silicone rubber chambers filled with collagen, laminin and fibronectin[J]. Biomaterials,2000,21(15):1541-1547.
[24]袁炜庆,等.小间隙外膜袖缝合法的临床疗效观察.微创医学.2008,3(6)：593-594.
[25]胡勇,等.甲壳胺膜管修复不同长度神经缺损的实验研究.中国临床康复.2004.5,8(13)：2564-2565.
[26]Young RC,Wiberg M,Terenghi G.. Poly-3-hydroxybutyrate (PHB):a resorbable conduit for long-gap repair in peripheral nerves[J]. Br J PlastSurg,2002,55 (3):235-240.
[27]Matsumoto K,Ohnishi K,Kiyotani T,et al. Peripheral nerve regeneration across an 80-mm gap bridged by a polyglycolic acid (PGA)-collagen tube filled with laminin-coated collagen fibers:a histological and electrophysiological evaluation of regenerated nerves [J]. Brain Res,2000,868(2):315-328.
[28]Matsumoto K,Ohnishi K,Sekine T,et al. Use of a newly developed artificial nerve conduit to assist peripheral nerve regeneration across a long gap in dogs [J]. ASAIO J,2000,46(4):415-420.