Experimental Study Of The Treatment Of Peripheral Nerve Injury Or Defect By End-to-side Neurorrhaphy

End-to-side neurorrhaphy is a surgical technique for peripheral nerve reconstruction in cases in which end-to-end neurorrhaphy is not an option. End-to-side neurorrhaphy was first used clinically in the late 1800s as a method of nerve repair after peripheral nerve injuries. Despite experimental evidence supporting its potential usefulness and modest clinical success, the technique was largely abandoned, and end-to-end neurorrhaphy increased in popularity. In the early 1990s,Viterbo et al. revived interest in end-to-side neurorrhaphy when they demonstrated successfully nerve regeneration and muscle reinnervation with end-to-side neurorrhaphy in a rat model. Subsequently, numerous investigators demonstrated functional neuromuscular recovery with end-to-side neurorrhaphy in animal models. Clinically, May et al. demonstrated successful facial reanimation through an end-to-side hypoglossal-facial nerve jump graft in a series of 20 patient; End-to-side neurorrhaphy has also been used with cross-facial nerve grafts for the treatment of unilateral facial palsy; in selected patients, reinnervation of the orbicularis oculi and lower facial musculature has been achieved. In the extremities, end-to-side neurorrhaphy has been used to ameliorate the dysesthesia associated with sural nerve harvest, and has also been used in ulnar nerve long defect domestically of which the results were amazing.Despite the promising clinical utility, many problems need to be resolved, such as the efficiency of the end-to-side neurorrhaphy compared with end-to-end neurprrhaphy and nerve graft in nerve defect and nerve injuries at high level．If the both ends of the severed nerve sutured to the normal nerve by end-to-side neurorrhaphy, can the regenerated nerve fibers be induced to their original tube and be re-connected by themselves?what is the effect of this double neurorrhaphy to the recovery of the function of the injured nerve?To simulate the clinical situation of peripheral nerve injury and repair, a variety of techniques has been used in the present study, including end-to-end neurorrhaphy, end-to-side neurorrhaphy, double end-to-side neurorrhaphy and nerve graft by double end-to-side neurorrhaphy．The purpose of this study is to compare the efficiency of the different techniques in treating peripheral nerve injury at high level and the nerve defect.Materials and methods:70 sides of hindlimbs of thirty-five New Zealand White rabbits were treated and divided into 7 groups, each group including 10 sides: Nerve graft group: the common peroneal nerve was transected and a nerve section of 20 mm- long was removed ,the defect was repaired by this nerve section with end-to-end anastomosis.Nerve end-to-end neurorrhaphy group: the common peroneal nerve was sharply transected 10 mm below its bifurcation from the sciatic nerve and re-sutured by end-to-end anastomosis. One end-to-side neurorrhaphy group: the common peroneal nerve was transected 10mm below its bifurcation and the proximal peroneal nerve stump was ligated and reflected superiorly to prevent spontaneous reinnervation. The distal end of the peroneal nerve was sutured to the intact tibial nerve in an end-to-side fashion, with a 1.5mm epineurial window created by resecting a portion of the external epineurium,at the level of 40 mm below the bifurcation. Double end-to-side neurorrhaphy groupⅠ: the common peroneal nerve was transected 10mm below its bifurcation, the proximal and the distal end were sutured to the same side of the intact tibial nerve by end-to-side anastomosis with a 10 mm distance, the epineurial windows were also created along the tibial nerve trank. Double end-to-side neurorrhaphy group Ⅱ: the technique was the same as that of Double end-to-side neurorrhaphy Ⅰ group except the distance between the proximal and distal end of the peroneal nerve was 20 mm. Nerve graft by double end-to-side neurorrhaphy group: the common peroneal nerve was transected 10mm below its bifurcation and re-sutured by end-to-end anastomosis, a 10 mm-long nerve...