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目的探讨神经鞘膜闭合术对坐骨神经损伤大鼠残端神经瘤的预防作用。方法选取SD大鼠30只,随机分入对照组和实验组各15只。切断坐骨神经后,对照组近端旷置,远端切除1.0cm,实验组行近端神经鞘膜闭合。16周后处死大鼠,观察近端神经残端的形态学变化,包括大体形态及光镜下形态,行Glee’s轴索染色观察残端的组织学结构。结果实验组术后4周,坐骨神经略变细;术后16周缝合处的神经外径已恢复正常,没有明显的梭形膨大或增粗。光镜下见通过缝合处的再生轴突排列整齐,极性较一致,未见神经瘤形成,残端神经纤维稀疏,排列一致,神经残端由完整的外膜包绕,外膜有所增厚。对照组术后4周,神经近端轻度膨大,残端闭合;术后16周,近端神经瘤形成,体积大于正常神经直径的2倍以上。光镜下见神经残端瘤体内神经纤维扭曲缠绕成团,走向完全紊乱,瘤体内结缔组织增生,束膜间隙不清,瘤体由增生的结缔组织包绕。结论神经鞘膜闭合术对坐骨神经损伤大鼠残端神经瘤具有较好的预防作用,神经鞘膜闭合术后残端神经瘤发生率较低、程度较轻,其效果优于其他术式的干预效果,这对于残端神经瘤的临床干预具有一定的指导和借鉴意义。
Objective To investigate the preventive effect of nerve sheath on the stump neuroma in rats with sciatic nerve injury. Methods Thirty SD rats were randomly divided into control group and experimental group with 15 rats in each group. After the sciatic nerve was cut off, the control group was proximal exclusion and the distal resection was 1.0 cm. The proximal nerve sheath was closed in the experimental group. After 16 weeks, the rats were sacrificed to observe the morphological changes of the proximal stump, including gross morphology and light microscopic morphology. The histological structure of the stump was observed with Glee’s axon staining. Results At 4 weeks after operation, the sciatic nerve became slightly thinner. At 16 weeks after operation, the external diameter of the suture had returned to normal without obvious fusiform enlargement or thickening. Light microscopy through the sutured axonal arrangement neatly, the polarity is more consistent, no neuroma formation, stump nerve fibers sparse, arranged in line, the nerve stump surrounded by a complete outer membrane, the outer membrane increased thick. At 4 weeks after operation, the proximal nerve of the control group was slightly swollen and the stump closed. After 16 weeks, the proximal neuroma formed more than twice as much as the normal nerve. Light microscope, see the nerve stump tumor nerve fiber twisted into a group of wounds, to a complete disorder, the tumor tissue connective tissue hyperplasia, membrane space is unclear, the tumor surrounded by hyperplastic connective tissue. Conclusions Nerve sheath closure has a good preventive effect on stump neuromas in rats with sciatic nerve injury. The incidence of stump neuromas after nerve sheath closure is relatively low and to a lesser degree, which is superior to other surgical procedures Effect, which for the clinical intervention of stump neuroma has some guidance and reference.