Department of Orthopedics, Affiliated Hospital of Taditional Chinese Medicine
Xinjiang Uygur Autonomous Region Health Young Medical Science and Technology Talents Special Research, No. WJWY202034
目的 通过动物实验明确膈神经端侧移位下干后股恢复伸趾功能的有效性及安全性。方法 取SD大鼠24只，分为4组，每组6只，A组端侧移位：膈神经通过隐神经端侧移位至下干后股。B组端端移位：膈神经切断通过隐神经移位至下干后股。C组直接修复：切断下干后股直接缝合。D组：切断下干后股不予修复。术后观察功能情况，电生理检查，桡神经深支、下干后股逆向荧光示踪，观察脊髓节段阳性染色细胞。结果 AB两组波幅差异有统计学意义，潜伏期差异无统计学意义，C组刺激下干后股可在伸趾总肌记录到CMAP，波幅、潜伏期均优于AB两组，差异有统计学意义。ACD三组刺激膈神经均可在膈肌记录到CMAP，各组间比较波幅与潜伏期差异无统计学意义。C3C4脊髓节段前角发现阳性细胞，B组数量多于A组，且差异有统计学意义，而C组桡神经深支示踪至C8T1脊髓节段前角阳性细胞数量较AB两组示踪至C3C4脊髓节段多，且差异有统计学意义。结论 膈神经端侧移位修复下干后股可部分恢复伸趾功能是安全并有效的。
Objective to investigate the efficacy and safety of the end to side transfer of phrenic nerve to the posterior division of lower trunk in the recovery of toe extension. Methods 24 SD rats were divided into 4 groups with 6 rats in each group. In group A, the phrenic nerve was transferred end to side through the saphenous nerve to the posterior division of the lower trunk. In group B, the phrenic nerve was transected and transferred to the posterior division of the lower trunk through the saphenous nerve. Group C: direct repair: the posterior division of lower trunk was cut off and was sutured directly. Group D: the posterior division of lower trunk was not repaired after cutting off. The function, electrophysiological examination, retrograde fluorescence tracing of the deep branch of radial nerve and the posterior division of lower trunk，the fluorogold positive neurons were observed in Spinal cord segment. Results There was significant difference in amplitude between A,B two groups, but not in latency，in group C CMAP was recorded in the extensor digitorum communis muscle after stimulate the posterior division of lower trunk，The amplitude and latency were better than A,B two groups, and the difference was statistically significant. CMAP was recorded in diaphragm in A,C,D groups, there was no significant difference in amplitude and latency among the groups. There were more positive cells in the anterior horn of c3c4 spinal cord in group B than in group A, and the difference was statistically significant,The number of positive cells from deep branch of radial nerve to c8t1 spinal cord segment in group C was more than that from group AB to c3c4 spinal cord segment, and the difference was statistically significant. Conclusion It is safe and effective to partially recover the function of toe extension with phrenic nerve end to side transfer to repair the posterior division of lower trunk.