目的 比较靶向肌肉神经功能重建（targeted muscle reinnervation，TMR）和靶向神经功能替代（targeted nerve function replacement，TNFR）两种术式的疗效。 方法 将SD大鼠随机均分为假手术（Sham）组、单纯胫神经离断（TNT）组以及在TNT基础上建立模型TMR组和TNFR组，通过足迹分析、肌电信号（electromyography，EMG）、Sihler’s肌内神经染色评价两种手术效果。 结果 TNFR组胫神经指数（-12.30±4.06）略大于TMR组（-13.79±5.28）；第8周TMR组和TNFR组患侧EMG幅值相较于TNT组明显增强（P<0.05），TNFR组患侧EMG幅值强于TMR组；Sihler’s肌内神经染色发现TNFR组和TMR组神经和肌萎缩程度较TNT组轻；TNFR组腓肠肌内侧头延续胫神经原有功能，相较于TMR组，其神经分支更加密集。 结论 TNFR术及TMR术均可延缓肌萎缩并促进运动功能重建，TNFR术的远期疗效较优于TMR术。
Abstract
Objective To compare the clinical efficacy of "targeted muscle reinnervation (TMR)" and "targeted nerve function replacement (TNFR)" for neurological reconstruction in patients with amputation. Methods SD rats were randomly divided into a Sham group, a simple tibial nerve dissection (TNT) group, a TMR group and a TNFR group. The two operative efficacy were evaluated by footprint blotting, electromyography (EMG), and Sihler's intramuscular nerve staining. Results (1) Analysis of the footprint blotting results showed that the tibial nerve index in the TMR group (-13.79±5.289) was slightly smaller than that in the TNFR group (-12.30±4.06). (2) at the 8th week, compared with the TNT group, the amplitude of EMG on the affected side was greater in the TMR and TNFR groups (P<0.05). The amplitude of EMG on the affected side in the TNFR group was greater than that of the TMR group.(3) Sihler's intramuscular nerve staining results showed that the degree of nerve and muscle atrophy in the TNFR and TMR groups was less severe than that in the TNT group. The medial head of the gastrocnemius muscle in the TNFR group inherited the original function of the tibial nerve, and its nerve branches were denser compared with those in the TMR group. Conclusions Both TNFR and TMR can delay muscle atrophy and promote motor function reconstruction, and the long-term efficacy of TNFR is better than that of TMR.
关键词
靶向肌肉神经功能重建 /
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靶向神经功能替代 /
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Sihler’s肌内神经染色 /
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足迹分析法 /
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肌电信号
Key words
Targeted muscle reinnervation /
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Targeted muscle nerve function reconstruction /
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Sihler's intramuscular nerve staining /
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Footprint analysis /
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Myoelectric signal
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参考文献
[1] 中国残疾人联合会. 2020年残疾人事业发展统计公报[R]. 2021.
[2] 王萍, 李沅衡, 李大宇, 等. 上肢感觉神经功能重建技术研究现状[J]. 中国临床解剖学杂志, 2020, 38(3): 359-362, 366. DOI: 10.13418/j.issn.1001-165x.2020.03.024.
[3] Mioton LM, Dumanian GA. Targeted muscle reinnervation and prosthetic rehabilitation after limb loss[J]. J Surg Oncol, 2018, 118(5): 807-814. DOI: 10.1002/jso.25256.
[4] 张裕, 黄剑平, 汪圆圆, 等. 神经肌肉功能重建术式对大鼠肱二头肌生物学功能影响的实验研究[J]. 中国康复医学杂志, 2018, 33(11): 1255-1260. DOI: 10.3969/j.issn.1001-1242.2018.11.001.
[5] 黄剑平, 李文庆, 杨琳, 等. 上肢经肱骨截肢神经功能重建研究[J]. 集成技术, 2016, 5(5): 30-37.
[6] Raspopovic S, Capogrosso M, Petrini FM, et al. Restoring natural sensory feedback in real-time bidirectional hand prostheses[J]. Sci Transl Med,2014, 6(222): 222ra19. DOI: 10.1126/scitranslmed. 3006820.
[7] Stephanie H, Wensman JP, Ferris DP. Locomotor adaptation by transtibial amputees walking with an experimental powered prosthesis under continuous myoelectric control[J]. IEEE Trans Neural Syst Rehabil Eng,2016, 24(5): 573-581. DOI: 10.1109/TNSRE.2015. 2441061.
[8] Ehmsen JT, Hke A. Cellular and molecular features of neurogenic skeletal muscle atrophy[J]. Exp Neurol, 2020, 331: 113379. DOI: 10.1016/j.expneurol.2020.113379.
[9] Borzuola R, Giombini A, Torre G, et al. Central and peripheral neuromuscular adaptations to ageing[J]. J Clin Med, 2020, 9(3): 741. DOI: 10.3390/jcm9030741.
[10]Pratt S, Shah SB, Ward CW, et al. Recovery of altered neuromuscular junction morphology and muscle function in mdx mice after injury[J]. Cell Mol Life Sci, 2015, 72(1): 153-164. DOI: 10.1007/s00018-014-1663-7.
[11]Lu W, Li JP, Jiang ZD, et al. Effects of targeted muscle reinnervation on spinal cord motor neurons in rats following tibial nerve transection[J]. Neural Regen Res, 2022, 17(8): 1827-1832. DOI: 10.4103/1673-5374.332153.
[12]Zhang SH, Shurin GV, Khosravi H, et al. Immunomodulation by Schwann cells in disease[J]. Cancer Immunol Immunother, 2020, 69(2): 245-253. DOI: 10.1007/s00262-019-02424-7.
[13]Feltri ML, Poitelon Y, Previtali SC. How schwann cells sort axons: new concepts[J]. Neuroscientist, 2016, 22(3): 252-265. DOI: 10.1177/1073858415572361.
[14]Mahar M, Cavalli V. Intrinsic mechanisms of neuronal axon regeneration[J]. Nature Reviews Neuroscience, 2018, 19(6): 323-337. DOI: 10.1038/s41583-018-0001-8.
[15] 李依依, 万利, 杨胜波. 面部和颈前部皮神经的Sihler's染色及意义[J]. 重庆医科大学学报, 2021, 46(8): 938-942. DOI: 10.13406/j.cnki.cyxb.002491.
基金
国家自然科学基金项目（81960419，81927804，8226045 6)；贵州省科技拔尖人才支持计划（黔教合KY字[2018]56）；遵义医科大学大学生创新项目（ZHCX202006，ZHCX201920）
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