| 摘要: | 周邊神經斷傷後，若沒有適當的處理，可能會造成神經瘤形成，使得神經無法順利再生。而在選用何種神經接合術來修補斷傷的周邊神經時，神經兩斷端的間距是最重要的考慮因素。神經斷端縫合術和神經束縫合術適用於神經較短斷裂間距之修補，但當神經斷傷間距太長時，神經移植術和神經管接合術是較適當的手術方法，但因神經移植段來源取得的困難，於是利用神經管接合術來修補較長的神經缺損成為較佳的選擇。 神經管接合術是將神經兩斷端手術縫合於神經管的兩端，並利用神經管來引導及支持神經纖維的再生。文獻中已經有多種不同的材料用來製作神經管，矽膠管就是常用的一種。另外，在神經管內添加刺激神經再生的物質，使再生神經在較短的時間內，跨過神經間距完成再生。而常用的神經再生刺激物質有神經生長因子、膠原蛋白、laminin 與fibronectin混合物等。 過去臨床上膠原蛋白常被用來充填神經管，作為刺激神經再生的物質，但因其製備過程較繁雜且價格昂貴。所以本研究以矽膠管分別充填明膠(gelatin)與經綠梔子素(genipin)交聯之明膠，並利用此神經管對截斷1 cm的大鼠坐骨神經做一接合，以觀察其對大鼠周圍神經再生的影響，並與矽膠管充填膠原蛋白和空管組做一比較。 實驗結果：一、神經再生成功率：空管組30﹪、膠原蛋白組90﹪、明膠組80﹪、綠梔子素交聯明膠組80﹪。二、再生神經組織切片比較：空管組有較多的軸突數（p<0.001），形態最為成熟；膠原蛋白組、明膠組、與綠梔子素交聯明膠組其再生軸突數雖較少，但軸突平均面積卻都比空管組大。實驗結果顯示明膠與綠梔子素交聯明膠和膠原蛋白一樣，都可促進大鼠坐骨神經再生軸突的成熟，但殘留於神經管內的膠狀物可能會影響軸突再生的過程，使得軸突再生數目相對於空管組減少了許多。; If the neurotmesis is not properly treated, the neuroma can happen. The gap length between the injured nerve ends is the most important factor in deciding the suturing methods of repairing severed peripheral nerve. End-to-end suturing and fascicular suturing methods are suitable to the shorter gaps. As for the large gaps, nerve grafting and nerve bridging methods are suggested. It is difficult to get the original source of nerve grafting method so that it is better choice to use nerve bridging method to repair the large gap of both ends of severed nerve. Nerve bridging technique is to put both ends of severed nerves in a tube, which can guide and support nerve fiber regeneration. There are many kinds of materials used for nerve guide tubes, such as the silicone tube which is most commonly used. To make it possible for the regenerating nerve across a longer gap in a shorter time, the nerve guide tube filled with nerve stimulants are used. The nerve stimulants commonly used include the mixture of nerve growth factor, collagen, laminini, and fibronectin. Collagen is another commonly used stimulants, however it also has several disadvantages, such as the complicated preparation procedures and high price. In this study, we therefore used the pure gelatin and the genipin cross-linking gelatin as the fillings in the silicone tubes to repair dissected rat sciatic nerves with 10 mm gaps. Nerves regenerating in both the fillings were then compared to those in the tubes loaded with collagen as well as the empty tubes. Experiment results: (1) The success rate of nerve regeneration: 30% in empty tube, 90% in tube with collagen, 80% in tube with gelatin, 80% in tube with genipin cross-linking gelatin. (2) Regenerated nerve section comparison: the regenerated nerve in the empty tube was most mature and had more axons (p<0.001). The rest 3 groups had less axon but their average areas are bigger than that of the empty tube. These results show that gelatin, genipin cross-linking gelatin, and collage could enhance the maturation of regenerated rat sciatic nerves. However, their residues in the tubes could impair the regenerating axons, thus decreasing their numbers successfully crossing the nerve gaps. |
