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目的 探讨肢体缓慢牵伸延长周围神经亚临床损伤的自然修复过程。方法 6 2只日本大耳白兔胫骨延长至 40 % ,停止延长后 2周、4周、8周时观察胫神经损伤自然修复的组织学及感觉诱发电位 (CSEP)的改变。结果 延长 40 %时 ,可见广泛的节段性脱髓鞘 ,朗飞氏结区增宽 ,且主要发生于大的有髓神经纤维 ;电镜下可见髓鞘呈双环状 ,空泡状改变及环形小体形成压迫轴突 ;并可见新形成的髓鞘 ;停止延长后随着时间的延长 ,这种改变逐渐修复 ;至 8周时基本恢复正常。肢体延长造成了胫后神经明显的电生理损害 ,且随着延长幅度的增加而加剧。停止延长后 2周 ,CSEP的潜伏期恢复约 5 0 %。停止延长 4周恢复约 6 5 % ,峰值、面积亦恢复约 5 0 %。停止延长 8周 ,各项指标均恢复 95 %以上。结论 缓慢牵伸下肢延长过程中周围神经的损害是可逆的 ,并可在短期内修复
Objective To investigate the slow healing of limbs to prolong the peripheral repair of subclinical nerve injury. Methods Twenty four Japanese white rabbits were extended to 40% of the tibia. Histological and sensory evoked potential (CSEP) changes of the tibial nerve injury were observed at 2, 4 and 8 weeks after the extension. Results extended 40%, we can see a wide range of demyelination, Longsfield junction broadening, and mainly occurs in the large myelinated fibers; under the electron microscope showed myelin was double ring, vacuolar changes and The ring-shaped body formed a compressed axon; and the newly formed myelin was observed. After the extension of the extension, the change was gradually repaired with the extension of time, and returned to normal by 8 weeks. Limb lengthening leads to significant electrophysiological damage of the posterior tibial nerve and is exacerbated by the increase in extension. Two weeks after the cessation of prolongation, the latency of CSEP recovered by about 50%. After a four-week extension, about 65% of the patients returned to their peak and their peak area returned to about 50%. Stop extended for 8 weeks, all indicators were restored more than 95%. CONCLUSIONS: Slow traumatic peripheral nerve damage during lower limb extension is reversible and can be repaired shortly