论文标题:血管束植入神经移植段修复周围神经缺损实验研究
Experimental Research on Nerve Graft Segment with Vascular Bundle Implantation in Repairing Peripheral Nerve Defect
论文作者 文益民
论文导师 范清宇,论文学位 硕士,论文专业 外科学（矫形外科）
论文单位 第四军医大学,点击次数 222,论文页数 92页File Size4208k
2000-05-01论文网 http://www.lw23.com/lunwen_849027/ 周围神经缺损, 神经移植 ,血管束植入, 实验 研究
peripheral nerve defect,nerve graft, implantation of vascular bundle, experimental study
长段而粗大的周围神经缺损一直是神经修复外科的一大难题，许多作者经各种实验研究及临床应用证实，对粗大而较长段的周围神经缺损，在行自体神经移植修复时，采用带血管神经移植其疗效远较不带血管神经移植为好，特别在神经受床为疤痕组织的情况下则效果更为显著。而目前采用血管束植入骨、骨髂肌和皮下组织，增加组织血运，提高成活能力，已被认为是一种重建组织血液循环的有效方法。本研究的目的是采用血管束植入游离神经移植段的方法，来探讨游离神经移植段的再血管化过程以及它们与神经再生的关系。 本研究以50只新西兰大白兔双下肢坐骨神经为实验对象。采用左右下肢实验对比，在双侧坐骨神经相同平面各造成25mm的缺损，同时将切取的坐骨神经段行交叉游离移植。右侧游离神经段采用血管束植入（血管束来自股部肌支）。左侧为对照组（不植入血管束）。在术后第3、7、10、14、21、42天时各时间组分别处死3只，以观察移植神经再血管化情况，其余按实验设计时间进行神经电生理、组织学等方面的观察。 结果显示：血管植入组术后3、7、10、14、21天，所观察的植入血管全部保持通畅。术后3天，血管已在神经外膜和束膜上形成微小分支。7天移植神经的中段已形成毛细血 第四军医大学硕士研究生毕业论文 管网，并向两端扩展，而自两端长入的血管则较少。14天至 刀 天，血管网己分布在移植神经段的全段及各层，并与两端 长入的毛细血管相吻合。而未植入血管束侧的移植神经段则 只有少量新生的毛细血管分布于神经外膜。N－MCV、潜速率 测定，在4周时两组测定值无明显差异，但在6周后其N． MCV、潜速率测定值则有显著性差异。血管束植入组移植神 经段的再生神经纤维数、运动终扳数亦明显多于不植入血管 束组。再生神经纤维直径恢复率也明显好于不植入血管组。 本研究表明：血管束植入神经移植段可早期重建移植神 经段血运，对移植神经的再生有明显的促进作用。
The thick and segmental peripheral nerve defects have always been very difficult to be repaired. Now it has been identified that the nerve auto grafting with blood vessel is much better than the simple nerve alltografting to repair the thick and segmental peripheral nerve defect, especially when the recipient is scar tissue. Because the vascular bundle grafting into bone, skeletal muscle and hypoderm has been thought to be an effective method to reconstruct blood circulation. We plant vascular bundle into the free nerve segment in order to study its revascularization process and relationship with neuranageresis. 50 New Zeland rabbits were used to creat 25mm defects on the sciatic nerve bylaterally, the right defects were filled by the left free herve segments with vascular bundle (from femoral artary and vein), and the left defect as control were filled with the right free nerve segment without vascular bundle. 3 rabbits were killed in 3, 7, 10,14, 2land 45days after operation, the whole nerve vascularization process was observed, all sample were assesed electrophysiologically and histologically. 7 The results showed the all grafted blood vessel kept open after 3, 7, 10, 14 and 21 days of operation. The fine vessel braneh could be found on epineurium and periheurium in 3 days, the capillary network has been formed in the midportion of the nerve segment and spread toward two sides in 7 days, from 14 to 21 days, the capillary network spreaded through the whole grafts and conrected with the capillaries from the two ends. Wheras there were only a few capillies on the epineurium of the contrel. The dertermination of N-MCV showed that there was no obvious difference between the two groups after 4 weeks, but after 6 weeks the difference became great. The regenerated nerofiber in the vascular bunde group was thicker that that in the control group, and the amount of motor end-plate in the former was greater that than in the latter. This study showed it was concluded that the nerve autografting with vascular bundle can help to reconstruct blood circulation and improve the neuranagenesis.
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