C3、4神经根转位修复C5、6神经后运动功能恢复情况观察
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摘要
目的观察C3、4神经根转位修复C5、6神经后运动功能的恢复情况。方法取健康成年SD大鼠60只,随机分为正常组、对照组和实验组。实验组将C3神经根与C5神经根吻合,C4神经根与C6神经根吻合。对照组将右侧C5、6神经根离断,不进行吻合。正常组不进行手术。饲养1、3个月后进行取材,采用电生理、组织学、免疫染色方法观察大鼠神经纤维及靶器官的改变情况。结果实验组术后3个月C5、6运动诱发电位潜伏期和波幅与正常组比较,差异无统计学意义(P>0.05)。实验组、对照组术后3个月肱二头肌肌湿质量、肌纤维横截面积与正常组比较差异有显著性(F=5.72、7.54,P<0.05)。实验组术后3个月C5、6有髓神经纤维计数、运动神经纤维计数均较正常组减少,差异有统计学意义(t=2.74～4.61,P<0.05)。结论 C3、4神经根转位修复C5、6神经后,受损臂丛神经出现再神经化,上肢运动功能可得到部分恢复。
Objective To investigate the recovery of motor function after C3,4 nerve root transposition for C5,6 nerve repair. Methods A total of 60 healthy adult Sprague-Dawleyrats were randomly divided into normal group,control group,and experimental group,with 20 rats in each group.In the experimental group,C3 nerve root was anastomosed with C5 nerve root,and C4 nerve root was anastomosed with C6 nerve root;in the control group,C5,6 nerve roots were avulsed without repair;no surgery was performed in the normal group.Samples were collected after 1 and 3 months of feeding,and electrophysiology,histology,and immunostaining were used to observe the changes in nerve fibers and target organ. Results At 3 months after surgery,there were no significant differences in the latency and amplitude of motor evoked potential in C5,6 between the experimental group and the normal group(P>0.05).At 3 months after surgery,there were significant differences in the wet weight of the biceps brachii and the cross-sectional area of muscle fibers between the experimental/control group and the normal group(F=5.72,7.54,P<0.05).Compared with the normal group at 3 months after surgery,the experimental group had significant reductions in the numbers of myelinated nerve fibers and motor nerve fibers in C5,6(t=2.74-4.61,P<0.05). Conclusion After C3,4 nerve root transposition for C5,6 nerve repair,neurotization is observed in the injured brachial plexus,with partial recovery of motor function of the upper extremities.
Objective To investigate the recovery of motor function after C3,4 nerve root transposition for C5,6 nerve repair. Methods A total of 60 healthy adult Sprague-Dawleyrats were randomly divided into normal group,control group,and experimental group,with 20 rats in each group.In the experimental group,C3 nerve root was anastomosed with C5 nerve root,and C4 nerve root was anastomosed with C6 nerve root;in the control group,C5,6 nerve roots were avulsed without repair;no surgery was performed in the normal group.Samples were collected after 1 and 3 months of feeding,and electrophysiology,histology,and immunostaining were used to observe the changes in nerve fibers and target organ. Results At 3 months after surgery,there were no significant differences in the latency and amplitude of motor evoked potential in C5,6 between the experimental group and the normal group(P>0.05).At 3 months after surgery,there were significant differences in the wet weight of the biceps brachii and the cross-sectional area of muscle fibers between the experimental/control group and the normal group(F=5.72,7.54,P<0.05).Compared with the normal group at 3 months after surgery,the experimental group had significant reductions in the numbers of myelinated nerve fibers and motor nerve fibers in C5,6(t=2.74-4.61,P<0.05). Conclusion After C3,4 nerve root transposition for C5,6 nerve repair,neurotization is observed in the injured brachial plexus,with partial recovery of motor function of the upper extremities.
引文
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[12]曹鹏克,王伟,李俊明,等.健侧C7神经联合多组神经移位治疗全臂丛神经根性撕脱伤正中神经功能随访[J].中国骨与关节损伤杂志,2015,30(5):449-451.
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[14]苌彪,全琦,孙逊,等.周围神经损伤后瓦勒氏变性及神经导管的研究与进展[J].中国组织工程研究,2017,21(10):1596-1603.
[15]李月珍,武庚,武杨,等.坐骨神经瓦勒变性大鼠许旺细胞生物学特性及分泌功能变化[J].中国组织工程研究,2014,18(33):5282-5287.
[16]徐筑秋,杨晓楠,祁佐良.细胞自噬在周围神经损伤及再生中研究进展[J].中国修复重建外科杂志,2017,31(1):122-125.
[17]陈泽卡,王沪宁,齐建国.施万细胞来源的Toll样受体在外周神经损伤及修复中的作用和机制[J].四川解剖学杂志,2013,21(2):54-57.
[18]王元元,洪毅,王雪菲,等.脊髓损伤大鼠远端神经元及骨骼肌的变化[J].中国纺织工程研究,2014,18(33):5323-5328.
[19]王元元,张军卫,洪毅,等.大鼠胸段脊髓损伤后后肢神经肌肉的自然变化[J].中国脊柱脊髓杂志,2015,25(3):264-273.
[2] ROVAK J M,TUNG T H.Traumatic brachial plexus injuries[J].Mo Med,2006,103(6):632-636.
[3] WIBERG M,BACKMAN C,WAHLSTRM P,et al.Brachial plexus injuries in adults.Early reconstruction for better clinical results[J].Lakartidningen,2009,106(9):586-590.
[4]杨明杰,史其林,顾玉东.丛外神经移位治疗臂丛神经损伤的进展[J].中国修复重建外科杂志,2005,19(11):902-905.
[5]顾玉东.臂丛神经根性撕脱伤治疗近期进展[J].中华显微外科杂志,2006,29(6):401-402.
[6]丁小珩,潘达德,张宏勋,等.多组神经转位修复臂丛神经上中干损伤[C]/中华医学会全国显微外科学术会议暨世界首例断肢再植成功50周年庆典.2013.
[7] YAMADA S,PETERSON G W,SOLONIUK D S,et al.Coaptation of the anterior rami of C-3and C-4to the upper trunk of the brachial plexus for cervical nerve root avulsion[J].J Neurosurg,1991,74(2):171-177.
[8] KAWAI H.Nerve surgery of the brachial plexus[M].Singapore:World Scientific,2015:136-138.
[9] TOS P,BATTISTON B,GEUNA S,et al.Tissue specificity in rat peripheral nerve regeneration through combined skeletal muscle and vein conduit grafts[J].Microsurgery,2000,20(2):65-71.
[10]NAKAMURA S,MYERS R R.Myelinated afferents sprout into laminaⅡof L3-5dorsal horn following chronic constriction nerve injury in rats[J].Brain Res,1999,818(2):285-290.
[11]阿不地合比尔·阿不拉,李平,依力哈木江·吾斯曼,等.膈神经与肋间神经移位修复臂丛神经根性撕脱伤[J].中国组织工程研究,2016,20(51):7660-7665.
[12]曹鹏克,王伟,李俊明,等.健侧C7神经联合多组神经移位治疗全臂丛神经根性撕脱伤正中神经功能随访[J].中国骨与关节损伤杂志,2015,30(5):449-451.
[13]顾立强,裴国献.周围神经损伤的基础与临床[J].北京:人民军医出版社,2001:160-161.
[14]苌彪,全琦,孙逊,等.周围神经损伤后瓦勒氏变性及神经导管的研究与进展[J].中国组织工程研究,2017,21(10):1596-1603.
[15]李月珍,武庚,武杨,等.坐骨神经瓦勒变性大鼠许旺细胞生物学特性及分泌功能变化[J].中国组织工程研究,2014,18(33):5282-5287.
[16]徐筑秋,杨晓楠,祁佐良.细胞自噬在周围神经损伤及再生中研究进展[J].中国修复重建外科杂志,2017,31(1):122-125.
[17]陈泽卡,王沪宁,齐建国.施万细胞来源的Toll样受体在外周神经损伤及修复中的作用和机制[J].四川解剖学杂志,2013,21(2):54-57.
[18]王元元,洪毅,王雪菲,等.脊髓损伤大鼠远端神经元及骨骼肌的变化[J].中国纺织工程研究,2014,18(33):5323-5328.
[19]王元元,张军卫,洪毅,等.大鼠胸段脊髓损伤后后肢神经肌肉的自然变化[J].中国脊柱脊髓杂志,2015,25(3):264-273.