| ObjectiveTo compare the effectiveness of nerve regeneration and target muscles recovery in peronneal nerve defect repaired by the combination of proximal nerve graft and distal end-to-side or side-to-side neuropathy with the only nerve graftMethod40 male Wistar rats were randomized into five groups,each with 8,A 10mm long defect in the proximity of right peronneal nerve to set up animal model of peronneal nerve defect. The right hind limb was experienced, and the left hind limb was contrasted. In the group A: the 10mm long nerve segment was transplant to the defect with the 10mm segment straight. In the group B: the proximal end of the peronneal nerve was implanted into vicinal muscle, while the distal end was sutured by end-to-side neurorrhaphy to the tibial nerve with removal of an epineurial window. In the group C: the proximal coaptation of peronneal nerve was same as group B, while the distal end was sutured by side-to-side neurorrhaphy to the tibial nerve with removal of an epineurial window. In group D: the coaptation of peronneal nerve defect was same as group A, while after the removal of an epineurial window in the distal peronneal nerve and the neighboring tibial nerve, a seg-ment of median nerve was bridged between the epineurial windows by end-to-side neu-rorrhaphy, In the group D: the coaptation of peronneal nerve defect was same as group A, while after the removal of an epineurial window in the distal peronneal nerve and the neighboring tibial nerve, the epineurial windows was sutured by side-to-side neuror-rhaphy.After 4,8 and 12 week, observed the general state of the right hind limbs, the appearance and adhesion of the nerve,recorded the latency, the complex muscular action potential of each group. After 12 weeks,observed the wet weight of tibialis anterior muscle, cross-sectional area of tibialis anterior muscle fibe, regenerated nerves and motor end plate by electrophysiological, histological and morphometric examination and evaluated their recovery rate. Processed these statistic by SPSS 16.0, demonstrate as±s, analysis of variance, size of test isα=0.05.ResultGeneral observation: After the operation,the right feet of all the rats were hypoali-mentation, such as gait changed, atrophy of tibialis anterior muscle and can't initiative ex-tend. After 4 weeks, all these phenomenon were getting better. After 8 weeks, the appear-ance of skin were turned normal, can initiative extend, but the movement were stiffness, the tibialis anterior muscle were still atrophy. In each group, the CAMP were degrade, the Lat were prolong, reinneration potential were few by detecting EMG. After 16 weeks, all the rats can initiative extend without stiffness, in each group, the peronneal nerves and the tibialis anterior muscles were thick, chubbiness and glossy. The CMAP were increased, the Lat were decurtated and the reinneration potential were normal by detecting EMG. The wet weight of tibialis anterior muscle, the recovery rate of cross-sectional area, regenerated nerves and motor end plate were applied with SPSS16.0 for one-way ANOVA and t test, analysis shows: the D and E group were better than the A group, P <0.05.A group was better than the B and C group, P <0.05,and in groups of D and E,B and C were no statis-tically significance,P> 0.05.ConclusionAfter the operation end-to-side neurorrhaphy or side-to-side neurorrhaphy, the donor nerves can regenerate and provide early neurotropic support the target muscles and the motor end plate which the receptor nerves generated. The operations which were combined the nerve defect can regenerate and provide early neurotropic support the target muscles, avoid the degeneration without nerve, so the combinate operation can prevent muscle at-rophy which are inreversible, and buy time for nerve regeneration in high nerve graft. |
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