| Peripheral nerve injury is common in clinical. It is often to meet thelack of the resource of the motive nerve in the recovery period, especially inthe brachiplex root avulsion. It used to recover with the nerve shift in thecervical plexus motive branch nerve, diaphragmatic nerve, intercostal nerve,uninjured side neck and so on, all of which have therapeutic effect. But thenerve mentioned above is tiny, the resource is limited and the motivation isnot enough, it only recovers a few functions of brachial plexus and damagesat different degree the functions of the resource of the origin nervemotivation. Therefore, it still can't get the excellent effect in clinical. In thisstudy, we cut the proximal end of the ischiadic nerve into 1/4, 1/3, 1/2 and2/3 and take them as the motive nerve resource. We suture and bridge theinterstice from the vena systemica, in order to study whether it can get theeffect of directly anastomose in the entirely nerve after the operation, andhow many proportions of the origin nerve needed can fundamental changethe situation of the lack of the nerve motive resource. We take the functionalrecovery of the nerve motivation as the focal point in the observation index,and evaluate the state of the function of the nerve motivation. Weinvestigate how many proportions of the proximal end of the nerve fiberremaining in the recovery of the peripheral nerve can renovate its functionwith end to end anastomosing in the interstice at different proportions. Thecontents related to this study have not been reported neither in the countrynor in the foreign countries.I. Material and methodWe choose 90 healthy, mature and male wister rats whose weightsrange from 350~400g, and classify them into four experimental groups andone control group. There are 20 rats in every experimental group and 10 ratsin the control group.(I) the method of the animal model buildingWe paralyse the bellies of the rats at 130mg/kg katamine, make them atprone position, fix the hind limbs abducens, snip the wool in the hind limband sterilize the fur in the routine method. Then, in the asepsis, we make a3cm oblique incision at the posterior part and blunt dissect along thespatium intermusculare in the lateral of the post-femur where there presentthe ischiadic nerve. We cut off the ischiadic nerve 0.5cm below themusculus piriformis and keep 1/4, 1/3, 1/2 and 2/3 out (others return to fixand suture at the point of 0.5cm from the proximal end) which will beanastomosed with the center angle of the section area under the proximateoperating microscope. We anastomose the distal end of the ischiadic nerveinterstice with the 10/0 uninjured partition line for sleeve jointing thejugular vein. All the rest parts are out of the veins sleeve jointed in theoperation. Keep the rest parts also out of the cut of the jugular vein sleevejointed (0.2cm) and suture the skin after placed the powder of thelaevomycetin (about 0.1g).(II) Experimental groupingA group: anastomosing 1/4 of the proximal end of the ischiadic nerveand the distal end of the ischiadic nerve which had been sleeve jointed fromthe jugular veins interstice (0.2cm), the rest 3/4 return to suture at 0.5cmfrom it. Feed for 12 weeks in different cages with the routine method afterthe operation.B group: almost the same to A group, only the proportion is 1/3. Feedfor 12 weeks in different cages with routine method after the operation 2/3.C group: almost the same to A group, only the proportion is 1/2. Feedfor 12 weeks in different cages with routine method after the operation 1/2.D group: almost the same to A group, only the proportion is 2/3. Feedfor 12 weeks in different cages with routine method after the operation 1/3.E group (control group): all the ischiadic nerve anastomose theinterstice after the operation. Feed for 12 weeks in different cages withroutine method after the operation(III) The measurement of the experimental index and the method1. The general index2. The examination of the electrophysiology3. The examination of the histological anatomy and morphology of thegastroc.3.1 The examination of the humid weight of the gastroc.3.2 The examination of the histological anatomy of the gastroc.4. The examination of the examples of the light microscopes4.1 The change in the histological anatomy of the nerve fiberregeneration of the ischiadic nerve.4.2 The change in the ultra micro structure of the nerve fiberregeneration.4.3 The observation with the transmission electron.II. Results(I) the general observation1. The nutritional status: the rats in every group all appear the ulcer inthe foot and skin after about 10 days. The color of the toenail is slight dim;the fur of the legs and the foot is rare and tarnished;show insensitive to thepain. There will appear the self-mutilation phenomenon and become fantasyto the blood after 20 days. The fur and ulcer will recovery after 2 month.The effect of the C, D, E group are obvious after 3 month, including thetoenails bloom, the fur of foot return to normal, most of the memberapproach to normal and show sensitive to the pain. But the effect in A, B isworse than C, D.2. The legs action state: All of the toenail can not initial extend, andshow the foot deformity of the right-post leg, limping at the right-post legand the atrophy and thinning of the muscle in legs. They can graduallyrecover the ankle extend action after 2 month. But there is obviouslyinflexible at the beginning. The walking and the concordant gradually turnto well with the time goes by. In the three hours, the extend ability is weakand some of them limping in A, B groups, well, the rats in C, D, E group arealmost recovery, including both of the right legs are symmetry. There is notlimping.(II) Observation under the operating microscopePresent the right ischiadic nerve after 12 weeks. We can see the raritasadherence between the stoma of the nerve and the periphery organization.There are proliferative vascular net in epineurium, the epineurium becomethick and all the stoma are continuous. There is not nerve tumor in theproximal stoma and there is not intumescence in part. The part of A, B beanastomosed is obviously thinner than the original nerve and the bloodvessel being bridged collapses. The proximal stomas in C, D groups areslightly thinner than the normal one and the vessel show don not slightlycollapse, which in E group is normal and there is not collapsing.(III) The results measured by electrophysiology.After the operation for 12 weeks, measuring the renovation nerveconduction velocity (MNCV) and the compound muscle activity potential(CMAP), the C, D groups are obvious better than A, B groups. Thedifference between A, B groups and E group has a very important meaning(P<0.01), but the difference between A group and B group (P>0.05). Well,the difference between C group and D, E groups in the index has nomeaning (P>0.05). The most wave record of the renovation nerveconduction velocity and the triceps rats active potential of the rats in everygroup.IV. The examination of the histological anatomy and morphologyof the gastroc.After the operation for 12 weeks, measure the proportion of the humidweight of the gastroc (the injury and the normal side), the diameter of themuscle fiber and the cross section area of the muscle fiber, which in C, D, Egroups are obviously higher than which in A, B groups. There is obviousdifference of statistics (P<0.01). There is no difference between C, D groupsand E group (P>0.05). The cross section area of A, B groups are obviouslysmaller than C, D, E groups, which in A group is minimum and in E groupis maximum. The muscle fiber is well-distributed and the cell nucleuseumorphism. All the muscle fiber show the atrophy at different degree,which in A, B groups are more sever and the muscle cell spaces widenobviously, well, in C, D group are more slight and the muscle cell spaceswiden slightly.(IV) The measuring results of the light microscope example in thechange in the histological anatomy and in the ultra micro structure of thenerve fiber regeneration of the ischiadic nerve1. To display the motor nerve fiber of the ischiadic nerve and thenervus sensorialis fiber with the acetylcholine esterase staining.2. neurohistology and image analysisThe ischiadic nerve is stained with Marsland and LFB. The axonshows black and the myelin shows blue. We can see only a few renovatedmedullated nerve fibers in A, B groups with magnifying glass to enlarge600times in the path-graph and word automatic analysis system. Thediameter of the axon of the nerve fiber is smaller and the thickness of therenovated medullary sheath is slice and the nerve arranges irregular. Thenumber of the renovated nerve in C, D groups is obviously increasing, thediameter of the axon augmentation, and the thickness of the renovatedmedullary sheath obviously widen.3. Transmission election microscope observations: the medullatednerve fibers in A group is little, the height is thickening which lamellarseparated. The axons become thin and the chondrosome is obviouslyreduced. The medullated nerve fibers in B is more than which in A group,the medullary sheath thicken partly which lamellar separated and the roughendoplasmic reticulum and the body of the marrow can be seen in theintracytoplasm of the lemmocyte;there are more medullated nerve fiber andnon-medullated nerve fiber in C group and the separation is less than Bgroup. And the chondriosome is more and the vacuole can be seen in thepart;there is more medullar nerve fiber in D group and the diameter islonger. The separation is slightly and the chondrsome is more.III. ConclusionAfter the injury of sciatic nerve, we anastomose the proximal end tothe distal end of the ischiadic nerve at different proportions with the methodof bridging (2mm) the interstice from the vena systemica. The result showsthat when recover the ischiadic nerve in the gap of 2mm and the proximalend of the ischiadic nerve gets over 1/2 of the original volume, it will educethe effect which the whole nerve can get. There is also some inspiration tosolve the lack of the resource of the motive nerve in clinical.
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