단측 문합한 신경의 재생에 관한 연구

Abstract

The conventional standards in neurorrhaphy was limited to end-to-end neurorrhaphy. If useful peripheral nerve regeneration could be accomplished with an end-to-side neurorrhaphy, it would open a new horizon of possibilities in terms of surgical intervention in peripheral nerve injuries. Functional restoration of a trarmcted distal nerve stump could be sought without regards to limitations posed by functional morbidity of the donor nerve. This study was designed on a new experimental model consisting of the rat peroneal nerve and correspanding muscle unit. In 15 Sprague-Dawley rats, the distal stump of the transected peroneal nerve was anastomosed to the side of the tibial nerve through an epineural window. At 3 months, EMG was performed and the results analyzed in reference to control group and nerve transected group. Histological study included toluidine blue staining of the regenerated nerve segment and H & E sections of the re-innervated muscle, Nerve regeneration was study using image analysis software - Image Pro after calibration of the software to a micrometer under x400 magnification. Changes of volume and morphology of the anterolateral crural muscle were documented by measuring perimeter of the crural muscle and morphometric study of each muscle fiber. The results were as following: 1. Nerve regeneration was evidenced in the end-to-side anastomosis group, but not in the transection group. 2. Regenerating myelinated nerve fibers were observed in the end-to-side anastomosis group, but no in the transection-only group. 3. The volumetric muscle atrophy was most severe in the transection-only group(p<0.005), though both end-to-side anastomosis group and transection-only group showed a measurable decrease in muscle mass compared to normal control group. 4. Average muscle fiber diameter was diametest in the control normal group, attophy being evidenced by the decreasing fiber diameter in end-to-side group and transection-only group in that order.(p<0.005) 5. The decrease in fiber diameter in both the transection group and end-to-side anastomosis group, was further reflected in the increase in absolute number of muscle fibers per unit area(p<0.005). But this difference in number of muscle fiber between transection group and end-to-side anastomosis group was statistically not significant. From this study, we were able to infer that useful nerve regeneration can be obtained by an end-to-side neurorrhaphy through an epineural window, as positively reflected in functional recovery of the target muscle.