组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2018, Vol. 14 ›› Issue (6): 314-319.doi: 10.3969/j.issn.1673-0364.2018.06.004

• 论著 • 上一篇    下一篇

臂丛各神经根切断后靶肌肉内代偿机制的实验研究

姜宗圆，熊章霞，欧阳阳刚，孙浩然，梁海，陈琪，刘岸雄，谢统明   

  1. 深圳市龙华区人民医院手外科
  • 收稿日期:2018-09-25 修回日期:2018-11-10 发布日期:2020-07-23

Experimental Study of Compensatory Mechanism in the Target Muscles after Amputation of Each Nerve Roots of the Brachial Plexus

JIANG Zongyuan,XIONG Zhangxia,OUYANG Yanggang,SUN Haoran,LIANG Hai,CHEN Qi,LIU Anxiong,XIE Tongming   

  • Received:2018-09-25 Revised:2018-11-10 Published:2020-07-23
  • Contact: 上海市显微外科重点实验室、卫生部手功能重建重点周围神经室开发课题(2015-2018年)

摘要： 目的 通过研究臂丛神经各根切断后主要靶肌肉内运动终板形态学和功能学的变化过程,探索臂丛神经各根在靶肌肉内分布特点和切断后的代偿机制。方法 120只雄性SD大鼠,随机分成5组,每组24只。右侧建成臂丛神经各根的切断模型,左侧为正常对照组。术后第1、4、8、12周,用乙酰胆碱酯酶染色和单纤维肌电图等方法,检测各神经根主要靶肌肉内运动终板形态学和功能学变化过程。结果 颈5神经根和胸1神经根切断后,靶肌肉内出现无代偿特征的Jitter图形,Jitter均值明显低于正常对照侧;颈6、颈7和颈8神经根切断后,出现明显的代偿性Jitter改变,但只在颈7神经根切断后第1～4周Jitter均值逐渐增大,均明显高于对照组(P<0.05),第8～12后恢复正常;其余各神经根切断后Jitter均值明显低于对照组(P<0.05);臂丛神经各根切断后靶肌肉内的MCD分布图表明,仅在颈7神经根切断后会出现明显代偿变化。靶肌肉内运动终板面积逐渐扩大,乙酰胆碱酯酶染色逐渐变淡,直至消失的情况出现在颈5神经根和胸1神经根切断后;颈6神经根切断术后靶肌肉内运动终板变化与颈8神经根切断术后几乎一致,大部分运动终板消失,但仍有部分面积扩大,淡染的运动终板存在;颈7神经根切断术后第4～8周,在某些区域能发现少数异常的运动终板,到第12周后,运动终板的大小、形态和染色深浅全部恢复正常。结论 颈7、8神经根切断后靶肌肉内出现可能的代偿改变,颈6神经根切断后代偿变化极其有限,颈5、胸1神经根不具有代偿潜力。

关键词: 臂丛神经根, 乙酰胆碱酯酶染色, 单纤维肌电图, 运动终板

Abstract: Objective To evaluate the morphological and functional changes of motor endplate in target muscles,and to explore the distribution characteristics and compensatory mechanisms after severing each nerve root of brachial plexus.Methods One hundred and twenty male SD rats were selected and randomly divided into five groups(n=24).The cutoff model of each root of the brachial plexus was built on the right side,and the left side was set up as the normal control group.At weeks 1,4,8,and 12 after amputation of each nerve root of brachial plexus,the target muscles of experimental sides and normal sides were tested by ways of acetylcholinesterase staining and single-fiber electromyography.The data of morphological and functional changes of motor endplate in target muscles were recorded and analyzed by SPSS21.0 software.Results In the group of cervical 5th or thoracic first nerve root amputation,there was no compensatory Jitter pattern found from target muscles,and the mean value of Jitter was significantly lower than that of the control side.Significant compensatory Jitter changes occurred after cervical 6th,7th,and 8th nerve root cutoff.The mean value of Jitter increased gradually in the 1-4 weeks after the cervical 7 nerve root cut,which was significantly higher than that in the control group(P<0.05),and then returned to normal after 8-12 weeks.The Jitter of the rest of the nerve roots was significantly lower than that of the control group(P<0.05).Among those groups of brachial plexus nerve root amputation,the distribution of MCD in the target muscles showing obvious compensatory changes only was found in cervical 7th group.In the group of cervical 5th or thoracic first nerve root amputation,the target muscle motor endplate area gradually expanded,acetylcholinesterase staining became lighter than before,and motor endplate gradually disappeared.The change of motor endplate in target muscle after cervical 6th nerve root resection was almost the same as that after cervical 8th nerve root cut:most of motor endplates disappear

Key words: Brachial plexus nerve root, Acetylcholinesterase staining, Single-fiber electromyography, Motor endplate

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