肌桥构型的个性化差异对神经再生的影响

发布时间：2019-07-05 18:14

【摘要】： 周围神经缺损是骨科、显微外科及战伤外科治疗的一大难题。发展修复周围神经系统的技术已成为医学科学研究的热点,并已成为生物学家、生化工程师及材料学家的重要研究课题。有关周围神经缺损的研究可追溯到上世纪,自1880年Gluck、Vanlain首先报道用脱钙骨制成的骨性管道桥接周围神经缺损以来,众多学者分别使用动脉、静脉、筋膜管、硅胶管、胶原管、聚乳酸管及人羊膜、基底膜管和变性骨骼肌等[1,2]桥接周围神经缺损。因为骨骼肌桥本身是生物性自身组织,且具有与周围神经组织相似的纤维状结构。诸如骨骼肌与周围神经纤维的形状及都具有外膜、束膜和内膜,不存在免疫排斥问题。所以国内、外学者对此进行了大量的实验研究。目前,在修复周围神经缺损的研究中,肌桥对再生神经的诱导作用已无异议。但是,骨骼肌条被桥接后,缺损神经的再生的效果颇不一致。笔者认为影响神经再生的因素很多,其中肌桥构型的个性化差异可能是一个重要的原因。为此,为探求更为理想的肌桥本研究对取材于犬的不同部位的肌条内肌纤维相对长度和截面积进行镜下观测及桥接缺损神经的实验观察。结果显示,缝匠肌的肌条内肌纤维与肌条长轴平行并且多与肌条等长;指浅屈肌肌纤维走向与肌条长轴夹角较大而且不与肌条等长。不同肌条的肌纤维截面积有很大差异,其中肌纤维走向与肌条长轴夹角较大的肌纤维的截面积也较大。由相对长度较大的肌纤维为主要构成的肌桥桥接缺损神经的再生效果较好。从而得出,取材于不同骨骼肌的肌桥内的肌纤维相对长度和截面积存在个性化的差异。在肌肉桥接神经的研究中仅仅将外观为长条状的肌肉沿其长轴纵行切取肌桥是不够的,必须考虑到肌条内肌纤维方向与肌条长轴的关系及其可能产生的影响。即以相对长度较大但截面积较小的肌纤维为主要构成的肌桥桥接的缺损神经的再生效果较好,因此,缝匠肌肌桥可能是一种较理想的肌桥。
文内图片：

图片说明：缝匠肌肌桥分离示意图
[Abstract]:Peripheral nerve defect is a difficult problem in orthopaedics, microsurgery and war injury surgery. The development of techniques for repairing the peripheral nervous system has become a hot topic in medical science, and has become an important research topic for biologists, biochemical engineers and material scientists. The study of peripheral nerve defects can be traced back to the last century. Since 1880 Gluck,Vanlain first reported that bone ducts made of decalcified bone were used to bridge peripheral nerve defects, many scholars used arteries, veins, fascia tubes, silicone tubes, collagen tubes, polylactic acid tubes and human amniotic membrane, basilar canal and denatured skeletal muscle to bridge peripheral nerve defects. Because the skeletal muscle bridge itself is biological self-tissue, and has the fiber-like structure similar to the peripheral nerve tissue. Such as skeletal muscle and peripheral nerve fiber shape and have outer membrane, fasciculus and intima, there is no immune rejection problem. Therefore, domestic and foreign scholars have done a lot of experimental research on this. At present, there is no objection to the induction of regenerated nerve by muscle bridge in the study of repairing peripheral nerve defect. However, after the skeletal muscle strip was bridged, the regeneration effect of defective nerve was quite inconsistent. The author believes that there are many factors affecting nerve regeneration, among which the individualized difference of muscle bridge configuration may be an important reason. Therefore, in order to explore a more ideal muscle bridge study, the relative length and cross section area of muscle fibers in different parts of canine muscle strips were observed under microscope and the defective nerves were bridged. The results showed that the intramuscular fibers of sartorius muscle were parallel to the long axis of muscle strips and were as long as those of muscle strips, and the direction of superficial flexor muscle fibers was larger than that of muscle strips and was not as long as that of muscle strips. The cross section area of muscle fibers of different muscle strips is very different, and the cross section area of muscle fibers with large angle between the direction of muscle fibers and the long axis of muscle strips is also larger. The regeneration effect of muscle bridge defect nerve, which is mainly composed of relatively long muscle fibers, is better. It is concluded that there are individualized differences in the relative length and cross section area of muscle fibers in different skeletal muscle bridges. In the study of muscle bridge nerve, it is not enough to cut the muscle bridge along its long axis, and the relationship between the direction of muscle fiber in muscle strip and the long axis of muscle strip and its possible influence must be taken into account. That is to say, the muscle bridge, which is mainly composed of muscle fibers with large relative length but small cross section area, has better regeneration effect, so the sartorius muscle bridge may be an ideal muscle bridge.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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