Neurorrafia término-lateral com neurotização muscular direta associada à neurorrafia término-terminal, visando à recuperação funcional do músculo alvo: estudo em ratos
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Data
2010-02-09
Autores
Reis, Fábio José [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
As injúrias aos nervos periféricos levam à perda parcial ou total da função sensorial e ou motora, determinando aos indivíduos, prejuízos emocionais, sociais e financeiros. Apesar de existirem diversos métodos microcirúrgicos para a reparação destas áreas desnervadas, apenas uma recuperação limitada pode ser obtida. Deste modo, nosso objetivo foi avaliar se a associação de duas técnicas de reparo nervoso, um enxerto de nervo com neurorrafia término-lateral (NTL) e neurotização muscular direta (NMD) associados a uma neurorrafia término-terminal (NTT), podem superar o reparo funcional insatisfatório obtido com as diferentes técnicas empregadas isoladamente; se a utilização de outra via de reinervação poderia prejudicar a recuperação funcional obtida apenas com a NTT; se a associação de dois enxertos poderia aumentar a taxa de recuperação funcional obtida com um enxerto. Para tanto, foram utilizados 140 ratos machos Wistar, divididos em 7 grupos: G1 - Normal; G2 - Desnervado; G3 - NTT; G4 - NTT + enxerto simples (NTL e NMD); G5 - NTT + enxerto duplo; G6 - enxerto simples; G7 - enxerto duplo. O nervo fibular foi seccionado e imediatamente após, foi realizada a NTT. Os enxertos foram realizados com segmentos do nervo sural, coletados para esse propósito. O segmento do nervo sural teve seu coto proximal suturado por NTL à lateral do nervo tibial, sem janela epineural, e seu coto distal implantado no músculo tibial cranial, através de NMD. Após 6 meses, foi realizada a avaliação funcional da marcha, estudo eletrofisiológico, avaliação da massa do músculo tibial cranial (MTC), avaliação histológica do músculo e dos segmentos do nervo fibular e dos enxertos. Os resultados foram submetidos à ANOVA e, se detectada diferença estatística, ao teste de Tukey. Na avaliação funcional da...
The injuries to peripheral nerves causes total or subtotal loss of sensory and/or motor function, with social and financial problems. In spite of different microsurgical techniques, the results of peripheral nerve repair have today reached a plateau where functional recovery is still unsatisfactory. We tested the efficacy of association of two microsurgical techniques, end-to-side neurorrhaphy (ESN) and direct muscle neurotization (DMN), with nerve graft, and end-to-end neurorrhaphy (EEN) to functional recovery of desnerved muscle; if the other offer to reinnervation could affect the functional recovery of EEN; if the association of two nerves grafts could increase the functional recovery achieved with one nerve graft. 140 rats, male, Wistar, were divided into seven groups: G1 - normal; G2 - desnerved; G3 - end-to-end neurorrhaphy (EEN); G4 - EEN + single graft (ESN and DMN); G5 - EEN + double graft; G6 - single graft; G7 - double graft. The peroneal nerve was transected and immediately re-anastomosed with EEN. The grafts were making with the sural nerve. The proximal stump of sural nerve was sutured to the tibial nerve with ESN, without epineural window. The distal stump was implanted into the lateral head of the tibial cranial muscle (TCM). After six months, the animals were subjected to Walking Tracks Analysis, electrophysiologic tests, sacrificed, and the muscles and nerves of interest were taken to examination. There aren’t differences significant to functional evaluating among groups G1 (normal), G3, G4 and G5. The group G7 had better recovery than G6 and G2 (desnerved), however worst than G1, G3, G4 and G5. In the electrophysiologic tests, there wasn´t differences among G3, G4, G5 and G7. However, were better than G2, and worst than G1. In the mass of tibial cranial muscle, there weren´t difference among... (Complete abstract click electronic access below)
The injuries to peripheral nerves causes total or subtotal loss of sensory and/or motor function, with social and financial problems. In spite of different microsurgical techniques, the results of peripheral nerve repair have today reached a plateau where functional recovery is still unsatisfactory. We tested the efficacy of association of two microsurgical techniques, end-to-side neurorrhaphy (ESN) and direct muscle neurotization (DMN), with nerve graft, and end-to-end neurorrhaphy (EEN) to functional recovery of desnerved muscle; if the other offer to reinnervation could affect the functional recovery of EEN; if the association of two nerves grafts could increase the functional recovery achieved with one nerve graft. 140 rats, male, Wistar, were divided into seven groups: G1 - normal; G2 - desnerved; G3 - end-to-end neurorrhaphy (EEN); G4 - EEN + single graft (ESN and DMN); G5 - EEN + double graft; G6 - single graft; G7 - double graft. The peroneal nerve was transected and immediately re-anastomosed with EEN. The grafts were making with the sural nerve. The proximal stump of sural nerve was sutured to the tibial nerve with ESN, without epineural window. The distal stump was implanted into the lateral head of the tibial cranial muscle (TCM). After six months, the animals were subjected to Walking Tracks Analysis, electrophysiologic tests, sacrificed, and the muscles and nerves of interest were taken to examination. There aren’t differences significant to functional evaluating among groups G1 (normal), G3, G4 and G5. The group G7 had better recovery than G6 and G2 (desnerved), however worst than G1, G3, G4 and G5. In the electrophysiologic tests, there wasn´t differences among G3, G4, G5 and G7. However, were better than G2, and worst than G1. In the mass of tibial cranial muscle, there weren´t difference among... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Nervos - Enxerto - Estudos experimentais, Musculos, Neurorrafia, Direct muscle neurotization, End-to-side neurorrhaphy, Peripheral nerve
Como citar
REIS, Fábio José. Neurorrafia término-lateral com neurotização muscular direta associada à neurorrafia término-terminal, visando à recuperação funcional do músculo alvo: estudo em ratos. 2010. 155 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.