摘要
目的 对快速和缓慢面神经延长进行比较研究 ,验证快速面神经延长的可行性 ,为临床应用神经延长术修复面神经缺损提供依据。方法 用自制的神经延长器以不同速度延长面神经颊支 ,快速延长组 10mm/ 10min ,缓慢延长组 1 5～ 2 0mm/d ;在不同时间点检测颊肌肌电图(EMG)、神经传导速度 (NCV) ,并观察神经的病理形态学改变 ;在延长结束后切除一段神经再做端端外膜缝合 ,设神经移植组作为对照 ;自延长开始计时 ,第 15周用EMG和NCV评估神经功能的恢复情况。结果 延长结束后 1h内神经都有不同程度回缩 ,快速组回缩 (37 6± 4 5 ) % ,缓慢组 (8 2± 2 1) % ;快速组延长极限为 (30 0± 2 5 ) % ,缓慢组为 (33 5± 2 5 ) % ;除去回缩率延长极限分别为18 7%和 31 8% ;在极限范围内两组做同等幅度延长 ,快速组神经损伤的病理形态学表现重于缓慢组 ,但EMG、NCV无显著差异 ;在延长极限范围内 ,快速、缓慢延长组的修复效果与神经移植组比较无明显差别 ;如超极限延长 ,快速组超出 5 %其修复效果仍不受影响 ,而缓慢组一旦超过极限 ,其修复效果明显不如神经移植组。结论 快速面神经延长术是可行的 ;当缺损在原长 2 0 %以内可用快速延长法进行修复 ;若缺损为原长 2 0 %～ 30 % ,则应选用缓慢神经延长术 ;通过神经延?
Objective\ To investigate and compare the feasibility of acute and chronic expansion of the facial nerve so as to provide referable parameters for clinical practice.Methods\ Buccal branches of rabbits' facial nerve were expanded with the expander designed and manufactured by us.The nerve was elongated 10 mm per 10 min in the acute group,and 1 5～2\^0 mm per day in the chronic group.The nerve injury due to expansion,the nerve retraction after expansion and the limit of elongation were investigated.When the expansion was completed,1\^0 cm segments of the nerve in both acute and chronic groups were removed and epineurium neurorrhaphy was performed.The same length of the nerve in the control group was resected and replanted.Electromyogram(EMG) and nerve conductive velocity (NCV) were measured at the 15th week of expansion to assess the function of the repaired nerve.The pathological changes were also observed.Results\ ①The nerve retracted obviously during the first hour after expansion.The difference were significant between the acute group (37 6±4 5)% and the chronic group (8 2±2 1)%.②Excluding the retraction portion,the limit elongation was (18 7±2\^4)% and (31\^8±2\^4)% in acute and chronic group respectively.③To get the same elongation within the limit,nerve injury was more severe pathologically in the acute group than in the chronic one at the end of the expansion while EMG and NCV were not different considerably.④Within the limit elongation,the same result of neurorrhaphy was gained in the acute,chronic and the control groups.Conclusions\ Acute expansion of the facial nerve is feasible.When the defect is less than 20% of the nerve,acute expansion is indicated.When it is over 20% but less than 30%,a chronic method should be taken into consideration.The same outcome of repair should be gained if the expansion is within the limit elongation.\;
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2000年第4期229-232,共4页
Chinese Journal of Plastic Surgery
基金
全军九五中青年科研基金
关键词
组织扩张
周围神经延长术
面神经
Tissue expansion
Peripheral nerve elongation
Facial nerve
