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首页> 外文期刊>Journal of Brachial Plexus and Peripheral Nerve Injury >A quantitative evaluation of gross versus histologic neuroma formation in a rabbit forelimb amputation model: potential implications for the operative treatment and study of neuromas
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A quantitative evaluation of gross versus histologic neuroma formation in a rabbit forelimb amputation model: potential implications for the operative treatment and study of neuromas

机译：定量评估兔前肢截肢模型中神经瘤与组织神经瘤的形成：对神经瘤的手术治疗和研究的潜在影响

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BackgroundSurgical treatment of neuromas involves excision of neuromas proximally to the level of grossly "normal" fascicles; however, proximal changes at the axonal level may have both functional and therapeutic implications with regard to amputated nerves. In order to better understand the retrograde "zone of injury" that occurs after nerve transection, we investigated the gross and histologic changes in transected nerves using a rabbit forelimb amputation model.MethodsFour New Zealand White rabbits underwent a forelimb amputation with transection and preservation of the median, radial, and ulnar nerves. After 8 weeks, serial sections of the amputated nerves were then obtained in a distal-to-proximal direction toward the brachial plexus. Quantitative histomorphometric analysis was performed on all nerve specimens.ResultsAll nerves demonstrated statistically significant increases in nerve cross-sectional area between treatment and control limbs at the distal nerve end, but these differences were not observed 10 mm more proximal to the neuroma bulb. At the axonal level, an increased number of myelinated fibers were seen at the distal end of all amputated nerves. The number of myelinated fibers progressively decreased in proximal sections, normalizing at 15 mm proximally, or the level of the brachial plexus. The cross-sectional area of myelinated fibers was significantly decreased in all sections of the treatment nerves, indicating that atrophic axonal changes proceed proximally at least to the level of the brachial plexus.ConclusionsMorphologic changes at the axonal level extend beyond the region of gross neuroma formation in a distal-to-proximal fashion after nerve transection. This discrepancy between gross and histologic neuromas signifies the need for improved standardization among neuroma models, while also providing a fresh perspective on how we should view neuromas during peripheral nerve surgery.
机译：背景技术神经瘤的外科手术治疗包括从近端切除神经瘤至大致“正常”束的水平。然而，就截肢神经而言，轴突水平的近端改变可能具有功能和治疗意义。为了更好地理解神经横断后发生的逆行“损伤区”，我们使用兔子前肢截肢模型调查了横切神经的总体变化和组织学变化。正中，radial神经和尺神经。 8周后，从远端至近端的方向向臂丛神经获取截肢神经的连续切片。对所有神经标本进行定量组织形态计量学分析。结果所有神经在神经末梢末端处的治疗和控制肢之间的神经横截面积均显示出统计学显着增加，但在距神经瘤球根近10 mm处未观察到这些差异。在轴突水平，在所有截肢神经的远端可见到更多数量的髓鞘纤维。在近端部分有髓纤维的数量逐渐减少，在近端15mm或臂丛神经水平恢复正常。在治疗神经的所有部分，髓鞘纤维的横截面积均显着减少，表明萎缩的轴突改变至少向近端延伸至臂丛的水平。横断后从远端到近端的方式。总体神经瘤和组织神经瘤之间的这种差异表明需要在神经瘤模型之间改善标准化，同时也为我们在周围神经外科手术中应如何看待神经瘤提供了新的视角。

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