预变性舌下神经—面神经吻合时机的探讨

发布时间：2018-03-24 22:15

  本文选题：面神经损伤　切入点：吻合术　出处：《天津医科大学》2015年硕士论文

【摘要】：目的:本研究拟通过预变性的舌下神经行舌下-面神经端端吻合术修复完全性损伤的面神经,同时通过面容对称性评估面瘫程度、神经电生理检测面肌动作电位、组织学方法检测神经髓鞘形态,比较面神经损伤后不同时期舌下-面神经吻合术的治疗效果,旨在为面神经损伤修复选择一个最佳的时机。方法:56只大鼠随机分成8组,健康对照组,即时修复组,延迟1周修复组,延迟2周修复组,延迟3周修复组,延迟1月修复组,延迟3月修复组,完全面瘫组。同时,实验组大鼠面神经修复前1周分别制备预变性的自体舌下神经移植物,将预变性7天的舌下神经近端与面神经远端行端端吻合。通过面神经损伤后1周、修复术后3个月行鼻尖偏离指数的测量来评价面瘫的分级;面神经修复术后3个月进行神经电生理检测面肌动作电位的潜伏期和振幅;修复术后3个月电镜切片观察髓鞘再生形态及数量。结果:1、即时修复组与延迟1周修复组鼻尖偏离指数检测а角度优于其他各延迟吻合组(P0.05),这两组间差异无统计学意义(P=0.705)。延迟3月修复组鼻尖偏离指数检测а角明显小于其他各组延迟,延迟3周吻合组、延迟1月吻合组与延迟3月修复组之间a角差异无统计学意义(P0.05)。2、面肌动作电位检测结果显示即时修复组与延迟1周修复组的诱发性胡须垫肌肌电图的潜伏期短于其它各延迟修复组,这两组间差异无统计学意义(P=0.385)。延迟1周修复组的振幅大于即时修复组和其它各延迟修复组(P0.05);同时,延迟1月修复组与延迟3月修复组的振幅比其它各延迟修复组低,潜伏期比其他修复组延长。这说明从神经电生理指标看,延迟1周修复组神经再生效果不差于即时修复组。而当面神经延迟1月-3月吻合时,神经再生效果明显变差。3、计算各组面神经吻合口远端有髓纤维髓鞘数量,电镜观察面神经损伤远端神经再生有髓纤维髓鞘形态和数量,计算机图象分析系统计算神经髓鞘腔面积和髓鞘厚度。结果显示即时修复组和延迟1周修复组的神经有髓纤维髓鞘数量明显高于其它各延迟修复组(P0.05),这两组间差异无统计学意义(P=0.108);延迟1月组和延迟3月组的神经有髓纤维髓鞘数量低于其它各延迟修复组(P0.05),此二组间差异无统计学意义(P=0.181);电镜观察髓鞘形态,即时修复组与延迟1周修复组的神经髓鞘形态与正常组相似,表现为髓鞘形状为较规则的椭圆形,有髓纤维较粗,髓鞘板层结构致密,轴突的轴膜完整;即时修复组的髓鞘腔面积比延迟1周修复组和其它延迟修复组大,但即时修复组和延迟1周修复组相比差异无统计学意义(P=0.068);即时修复组、延迟1周修复组面神经再生有髓纤维髓鞘厚度与正常组无统计学差异,这两组间比较差异亦无统计学意义(P=0.057),但延迟1周修复组的髓鞘厚度稍大于即时修复组。此结果说明从面神经再生有髓纤维各指标看,延迟1周修复面神经的效果不比即时修复差。结论:以上研究表明,面神经损伤后,用面容对称性、神经电生理、再生神经有髓纤维形态等一系列指标综合评价面神经的再生情况,延迟1周修复有着不差于即时修复神经再生的效果。而延迟1月、3月修复组神经再生的效果比其它各延迟修复组差。临床可以此为参考,在即时吻合不允许的情况下,可适当延迟一段时间行面神经修复术,同时,尽量在面神经损伤后3个月内修复。
[Abstract]:Objective: This study through the pre degeneration of the hypoglossal nerve for hypoglossal facial nerve anastomosis to repair complete injury of facial nerve, and through face symmetry evaluation of facial palsy degree, electrophysiological examination of facial action potentials, histological detection of myelin formation, therapeutic effect of facial nerve anastomosis between different period after hypoglossal nerve injury, facial nerve injury repair to choose a best time. Methods: 56 rats were randomly divided into 8 groups, control group, immediate repair group, 1 week delay repair group, 2 week delay repair group, 3 week delay repair group, delayed repair group in January March, delay repair group, complete paralysis group. At the same time, the facial nerve of experimental rats repaired 1 weeks before were prepared under the autologous lingual predegenerated nerve graft, pre degeneration 7 days of hypoglossal nerve proximal and distal facial nerve anastomoses. The facial nerve injury After 1 weeks, measured 3 months after repair of nasal tip deviation index to evaluate the classification of facial paralysis; electrophysiological detection of facial action potential latency and amplitude of 3 months after the repair of facial nerve; observe the remyelination of morphology and number of 3 months after the repair of electron microscope. Results: 1, immediate repair group and 1 week delay repair group nasal deviation index than other delay angle detection. The anastomosis group (P0.05), there was no significant difference between the two groups (P=0.705). In March delayed repair group nasal deviation index was significantly less than the other groups. The detection angle of delay, delayed 3 weeks delayed anastomosis group, anastomosis group and delayed in January between March a angle repair group showed no significant difference (P0.05.2), facial action potential detection results show that the latency of immediate repair group and delayed 1 weeks to repair groups induced by whisker pads electromyography shorter than other delayed repair group, between the two groups There was no statistically significant difference (P=0.385). 1 weeks of repair delay amplitude were greater than those of immediate repair group and other delayed repair group (P0.05); at the same time, delay and amplitude of group delay in March January to repair repair group than other groups of low latency delayed repair, other than repair group. This shows that extended from neural electrophysiological index look, the 1 week delay repair group, the effect of nerve regeneration is not worse than the immediate repair group. In January -3 month delay neural anastomosis, the effect of nerve regeneration was significantly worse.3, calculate the facial nerve anastomosis of distal number of myelinated fiber myelin, electron microscope observation of facial nerve injury of the distal nerve regeneration of myelinated fiber morphology and number of myelin. The calculation of myelin sheath thickness and cavity area of computer image analysis system. Results show that the instant repair group and delayed 1 weeks the number of myelinated nerve repair group was significantly higher than that of other delayed myelin repair group (P0.05), 杩欎袱缁勯棿宸�寮傛棤缁熻�″�︽剰涔�(P=0.108);寤惰繜1鏈堢粍鍜屽欢杩，

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