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目的:观察大鼠喉返神经不同程度损伤后神经及甲杓肌变化、再生特点及其相互关系。方法:实验用SD大鼠95只,因感染死亡2只、手术死亡2只、运输途中死亡1只未计入统计外,将剩余90只大鼠分为完全损伤组(横断伤)及不完全损伤组(钳夹伤)各43例,对照组4例。造模成功后6h、12h、1d、3d、5d、1周、2周、3周及4周观察喉运动情况,甲杓肌肌电生理及病理组织学特点,喉返神经病理形态及超微结构变化特征。结果:大鼠喉返神经损伤后均即刻出现声带固定。完全损伤组未见声带活动恢复;不完全损伤组中41例于伤后2周声带活动恢复正常,另2例分别于伤后3周及4周声带活动恢复正常。完全损伤组伤后1d甲杓肌出现纤颤波,伤后4周出现神经再生电位;不完全损伤组甲杓肌于伤后2周内可观察到失神经电位,3周后肌电恢复正常。两组甲杓肌伤后4周均出现肌细胞卷曲变性、横纹溶解等失神经表现,完全损伤组随时间的延长肌萎缩逐渐加重,不完全损伤组损伤2周后肌萎缩现象开始逐渐好转。完全损伤组喉返神经损伤后,神经远端崩解变性程度较近端明显,伤后4周出现少量粗大的有髓神经纤维;不完全损伤组伤后1d有髓神经破坏最明显,随后逐渐好转,至伤后1周基本正常。完全损伤组Schwann细胞于伤后2周内出现吞噬现象,3周后开始出现不包绕神经纤维的Schwann细胞,以近端尤为明显;不完全损伤组伤后1周内可见Schwann吞噬现象,偶见凋亡及变性。炎性反应在完全损伤组更为严重,同时纤维母细胞及成纤维细胞逐渐增多,间质中胶原成分增加。结论:喉返神经完全损伤后,神经远端变性更为明显,伤后4周观察到再生神经,不完全损伤的喉返神经具有自我修复能力,结构恢复早于神经功能的恢复。Schwann细胞伤后可发挥吞噬作用,并有幼稚型出现。神经纤维崩解产物可能不是诱导巨噬细胞产生趋化作用的原因,但却加速巨噬细胞的迁移活化。
OBJECTIVE: To observe the changes and regenerative characteristics of nerves and thyronis muscle after different degrees of injury of the recurrent laryngeal nerve in rats and their correlations. Methods: Ninety-five SD rats were killed, two died due to infection, two died during operation and one died during transportation. The remaining 90 rats were divided into complete injury group (transection injury) and incomplete Injury group (clamp injury) 43 cases each, control group 4 cases. Throat motion was observed at 6h, 12h, 1d, 3d, 5d, 1week, 2weeks, 3weeks and 4weeks after successful model establishment. Muscle electrophysiological and histopathological features, pathological changes of the recurrent laryngeal nerve and ultrastructure Structural change characteristics. Results: Vocal cord fixation occurred immediately after injury of recurrent laryngeal nerve in rats. No injury of vocal cord was found in the complete injury group. In the incomplete injury group, 41 cases recovered normal in 2 weeks after injury, and the other 2 cases returned to normal in 3 and 4 weeks after injury respectively. Fibrillation wave appeared in the 1d post-injury group and nerve regeneration potential appeared 4 weeks after injury. The denervated potential of hypothyroid muscle in incomplete injury group was observed within 2 weeks after injury, and electromyogram returned to normal after 3 weeks . Muscle degeneration, striated lysis and other denervated neurons appeared in both groups at 4 weeks after sciatic nerve injury. Muscular atrophy gradually increased with the extension of time in complete injury group. Muscular atrophy began to improve after 2 weeks of incomplete injury . After injury of the recurrent laryngeal nerve, the degree of distal degeneration and degeneration of the nerve in the complete injury group was more proximal than that in the proximal lesion, and a few thick myelinated nerve fibers appeared in the lesion 4 weeks after injury. The damage of the myelinated nerve in the incomplete injury group was the most obvious one day after injury, Improved until 1 week after injury basically normal. Schwann cells completely damaged within 2 weeks after injury appeared phagocytosis, began to appear after 3 weeks without surrounding nerve fibers Schwann cells, especially in the proximal end; incomplete damage group within 1 week after injury can be seen Schwann phagocytosis, even See Apoptosis and degeneration. Inflammatory reaction in the complete injury group is more serious, while fibroblasts and fibroblasts gradually increased, interstitial collagen components increased. CONCLUSION: After the recurrent laryngeal nerve is completely damaged, the distal degeneration of the nerve is more obvious. The regenerative nerve is observed 4 weeks after injury, and the recurrent laryngeal nerve with incomplete injury has the ability of self-repairing, and the structure recovery is earlier than the recovery of nerve function. Schwann cells can play a role in phagocytosis, and a naive appearance. Neurofibrillary disintegration products may not be responsible for the chemotactic effects of macrophages, but they accelerate the migration and activation of macrophages.