大鼠膈神经移位修复前肢神经丛下干后股△

Transfer of phrenic nerve to posterior bundle of inferior trunk of forelimb plexus in rats

摘要:

［目的］评价确膈神经移位至前肢神经丛下干后股恢复伸趾功能的有效性及安全性。［方法］SD 大鼠 24 只随机分为 4 组，每组 6 只。端侧吻合组：膈神经与隐神移植物端侧吻合，移位至下干后股。端端吻合组：膈神经切断隐神经移植物端端吻合，移位至下干后股。原位吻合组：切断下干后股直接缝合。未修复组：切断下干后股不予修复。术后观察功能情况，行电生理检查，桡神经深支、下干后股逆向荧光示踪检测。［结果］术后第 7 周，端侧吻合组、端端吻合组刺激膈神经均可在伸趾总肌记录到 CMAP，两组间 CMAP 的波幅、潜伏期差异均无统计学意义 （P>0.05）；原位吻合组刺激下干后股可在伸趾总肌记录到 CMAP，其 CMAP 的波幅、潜伏期均显著优于端侧吻合组和端端吻合组 （P<0.05）。端侧吻合组、原位吻合组、未修复组刺激膈肌均可在膈肌记录到 CMAP，各组间比较波幅与潜伏期差异无统计学意义 （P>0.05）。神经示踪检测方面，端侧吻合组、端端吻合组手术侧桡神经深支示踪后均可在 C3/4脊髓节段前角发现阳性细胞，端端吻合组阳性细胞数量显著多于端侧吻合组 （P<0.05）。端侧吻合组、端端吻合组健侧下干后股示踪至 C8T1脊髓节段前角的阳性细胞数量显著多于原位吻合组、未修复组两组健侧桡神经深支示踪至 C8T1脊髓节段前角的阳性细胞数量（P<0.05）。［结论］膈神经端侧移位修复下干后股可部分恢复伸趾功能是安全并有效的。

Abstract:

[Objective] To evaluate the efficacy and safety of phrenic nerve transfer to the posterior bundle of inferior trunk of forelimb plexus (PBITFLP) to regain toe extension function in rats. [Methods] Twenty-four SD rats were randomly divided into 4 groups with 6 rats in each group. In the end-to-side anastomosis (the E-S group) , the phrenic nerve was anastomosed with the saphenous nerve graft by end-toside, and then transferred to PBITFLP. In the end-to-end anastomosis (the E-E group) , phrenic nerve was cut off and anastomosed with sa- phenous nerve graft by end-to-end suture, and transferred to PBITFLP. In situ anastomosis (the ISA group) , the PBITFLP was cut and then sutured in situ. In unrepaired anastomosis (the UR group) , the PBITFLP was cut only without anastomosis. Function observation, electro- physiological examination and reverse fluorescence tracer of the deep branch of radial nerve or posterior bundle of inferior trunk were con- ducted and compared among the 4 groups. [Results] At 7 weeks after operation, compound muscle action potential (CMAP) was recorded in the toe common extensor after stimulation of phrenic nerve in both the E-S group and the E-E group, which was not statistically significant in terms of amplitude and latency of CMAP between the two groups (P＞0.05) . In the ISA group CMAP was detected in the extensor by stimu- lation of the PBITFLP, in which the amplitude and latency of CMAP were significantly greater than those in the E-S and E-E groups (P＜ 0.05) . In addition, CMAP was detected in the diaphragm by stimulation in the E-S, ISA, and UR groups, without statistically significant dif- ferences in amplitude and latency among the groups (P＞0.05) . In terms of nerve tracer detection, positive cells were found in anterior horn of C_3/4 from deep branch of radial nerve in both the E-S group and E-E group, which in the E-E group was significantly greater than the E-S group (P＜0.05) . On the other hand, the number of positive cells traced from the deep branch of the radial nerve in the healthy side to the an- terior horn of C₈T₁ in the E-S group and the E-E group was significantly higher than those in the ISA group and UR group (P＜0.05) . [Conclusion] The end-to-side phrenic nerve transfer is safe and effective for restoring the function of toe extensor partially in this rat experiment.