摘要
对于神经血管化游离肌肉移植(NVMT)，以往研究多集中于血供及机械张力要素的达成方面，对三大要素之一的神经因素研究甚少，更缺乏实验和临床相对应的系统研究。本研究希望能弥补这一不足，在最佳血供及张力环境下，首次对照观察了神经蒂及移植神经长度与肌肉移植效果之间的交互关系。并在晚期面瘫治疗临床中，在统一供肌源条件下，验证考察了神经因素对NVMT最终效果的影响及其临床意义。
第一部分
犬胫前肌在不同神经蒂或移植神经长度环境下模拟游离移植的比较研究
材料和方法：
杂种犬28只(56侧)，在血运阻断90分钟，肌腱切断重缝等一致的模拟移植环境下，按神经的不同处理因素分成下列3组和6亚组：
a组(n=20)：一侧为长蒂神经组，另侧为短蒂神经组。
b组(n=20)：一侧为长神经移植组，另侧为短神经移植组。
c组(n=16)：一侧正常组，另侧为失神经对照组。
术后3，6，9个月时取材观察结果。
检测指标
1．大体观察：包括动物运行步态，足背溃疡发生情况，肌重和体重的对数比值，最大肌肉横截面积等。
2．肌肉收缩特性：包括测量肌肉单收缩张力(TwT)、最大强真收缩张力(TeT)、TwT／cm、TeT／cm、TwT／g、TeT／g、收缩时间(CT)、1／2舒张时间(1／2TR)、强直收缩张力到达峰值时间(TePT)、疲劳指数(FR)等十余项指标及各指标间的相关关系。
3．组化染色：包括还原型辅酶Ⅰ四唑盐(NADH-TR)，肌凝蛋白ATP酶(M-ATPase)组化染色以及对结果的定量分析。
4．荧光化学：使用哑啶橙荧光染料对上述组化染色的系列切片进行染色、荧光显微镜观察肌纤维的神经支配情况。
5．H．E及V．G染色观察肌肉失神经萎缩及复生的相关征象。
Tt is a serial study focused on how the nerve factor afect the functional and rnorphological results of the neurovascular muscle transplantation (NVMT) in experimental imitation and facial paralysed clinic.
In part I, the tibialic anterior muscles on both sides of ,28 dogs were imitatively transplanted with long (13cm) or short (3cm) nerve pedicle, long (10cm) or short (3cm) nerve graftion , also with innervated and denervated contral. 3,6 9months after the operation, they were examined by gross observation; contrlactile properties; poly-histochemical, fluorecent chemical, histological (H.E, V.G) stains.
The results showed:
1. Animal's gait of walking recovered to nearly normal within 8 weeks. The muscle weight and maximum areas descended in early 3 months and ascended gradually late.To 9 months, this wight could reach 60-70% of the normal in long and short nerve pedicle groups, but little lower in both of nerve grafting groups.
2. The twitch tension (TwT), maximum tetanic tension (TeT) and TwTcm~2 TwT/g, TeT/cm~2 , TeT/g droped more heavily in long nerve grafting, even to the end stage of this experiment, it still had significant difference with the normal contral.
3. In all of experimental groups, the items of contraction time (CT), 1/2 relaxtion time (1/2RT), tetanic tension to peak time (TePT) and fatigue rate ( FR) increased evidently, especially in both of long and short nerve grafting groups.
4. Most samples of each experimental groups had phenomenon of type grouping in differant size in M-ATPase and NADH-TR staining, which destroyed their normal mosaic pattern of type I and II muscle fibers. These grouping consisted mainly of type I muscle fibers which made the percentage of type I increasing greatly, There was an excellent correlation between these ratio and those items of contraction times course (CT, 1/2 RT) and FR.
5. The cross area of muscle fiber decreased in all the experimental groups but more heavy again in both of nerve grafting groups.
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