Periferik sinir cerrahisi sonrası derive edilmiş yüksek molekül ağırlıklı hiyaluronik asidin perinöral skar formasyonuna olan etkisi:Deneysel çalışma
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Date
2015
Authors
Karaoğlu, Ahmet
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Publisher
Uludağ Üniversitesi
Abstract
Periferik sinir kesisi sonrası iyileşmede fonsiyonel geri kazanım nadiren tam olmaktadır. Fonksiyonel geri kazanımı etkileyen bilinen birçok faktör vardır. Bunlardan da en önemlisi skar formasyonudur. Bu çalışmada derive edilmiş yüksek molekül ağırlıklı hiyalüronik asidin (HA gel) periferik sinir cerrahisi sonrası perinöral skar formasyonuna olan etkinliğini incelendi., Çalışmada 200-270 gram arasında değişen 40 adet erişkin Spraque Dawley cinsi dişi sıçan kullanıldı.Tüm sıçanlarda sağ siyatik sinire mikromakas ile kesi yapılarak 8/0 prolen ile hemen primer anastomoz yapıldı. Takiben sıçanlar; Grup 1 (n=10) Sham grubu; Oluşturulan sinir hasarını ve tamirini takiben mesafeye herhangi bir madde uygulanmayan, Grup 2 (n=10) Kontrol grubu; mesafeye topikal % 0,9 NaCl uygulanan, Grup 3 (n=10 ), Hiyalüronik asid (HA) deney grubu, Grup 4 (n=10) Derive edilmiş yüksek molekül ağırlıklı hiyalüronik asid (HA gel) deney grubu,şeklinde 4 gruba ayrıldı. 6. hafta sonunda incelemeye alınan deneklerin tamamı sakrifiye edilmeden önce Siyatik Fonksiyon İndeksi (SFİ) çalışmaları yapıldı. Sakrifiye edildikten sonra histopatolojik değerlendirmeye alındı. Sonuçlar istatistiksel olarak karşılaştırıldı. Sinir yapışıklığı, sinir ayrılabilirliği, SFİ değerleri, Skar Formasyon İndeksi'nin, fibrozisin Grup 4'te diğer gruplarla kıyaslandığında istatistiksel olarak anlamlı olduğu (p<0.05), fibroblast ve iltihabi hücre sayısının Grup 3'te daha az olduğu saptanmıştır.Ancak adezyon ve aksonal organizasyon değerleri bakımından istatistiksel olarak anlamlı fark saptanmadı (p>0.05) . Sonuç olarak; HA gel'in periferik sinir kesisi ve primer anastomoz modelinde gelişen skar dokusunun, fibrozisin azaltılmasında olumlu etkileri olduğu gösterilmiştir. Daha ileri çalışmalar ile klinik pratikte uygulama alanı bulacağı kanaatindeyiz.
After the peripherical nerve discconection, full functional recovery in healing process rarely happens. Many different factors effect functional recovery. The most important factor is scar formation. In this work, we analyzed the efficiency of derived hyaluronic acid (HA gel) with high moleculer weight in perinoral scar formation after peripherical nerve damage. 40 adult Spraque Dawley type female rats are used in this work. Their weight changes between 200-270 gr. Immediately primary anastomosis with 8/0 pollen together with the fraction by micro-scissors is done to right sciatica nerve. In following, the rats are divided into groups. The first group is Group 1 (n=10) Sham group which is no any stuff applied to the distance after the formation of nerve damage and reperation, the second group is Group 2 (n=10) control group, which is topical 0.9% NaCl applied to the distance, the third group is Group 3 (n=10) , hyaluronic acid(HA) experiment group, and the fourth group is Group 4 (n=10), hyaluronic acid(HA gel) with derived high molecular weight experiment group. At the end of the sixth week, all test subjects which are still alive were sacrified. Before the rats were sacrified, sciatica function index(SFI) works done. After they were sacrified, histopathological analyzeses were done. Nerve cohesiveness,nerve participation,SFI values,fibrosis and Scar Formation Index were statistically significant in Group 4 (p<0.05), fibroblasts and number of inflammatory cell were less in Group 3 according to other groups. However, in adhesion and axonal organization values,there were not statistically significant difference (p>0.05) . As a result, this work shows that peripheral nerve disconnection of hyaluronic acid (HA gel) and scar tissue in primary anastomosis model have positive effects in decreasing fibrosis. We think that the results which are taken from this work and the further investigations will have an application space in clinic practice.
After the peripherical nerve discconection, full functional recovery in healing process rarely happens. Many different factors effect functional recovery. The most important factor is scar formation. In this work, we analyzed the efficiency of derived hyaluronic acid (HA gel) with high moleculer weight in perinoral scar formation after peripherical nerve damage. 40 adult Spraque Dawley type female rats are used in this work. Their weight changes between 200-270 gr. Immediately primary anastomosis with 8/0 pollen together with the fraction by micro-scissors is done to right sciatica nerve. In following, the rats are divided into groups. The first group is Group 1 (n=10) Sham group which is no any stuff applied to the distance after the formation of nerve damage and reperation, the second group is Group 2 (n=10) control group, which is topical 0.9% NaCl applied to the distance, the third group is Group 3 (n=10) , hyaluronic acid(HA) experiment group, and the fourth group is Group 4 (n=10), hyaluronic acid(HA gel) with derived high molecular weight experiment group. At the end of the sixth week, all test subjects which are still alive were sacrified. Before the rats were sacrified, sciatica function index(SFI) works done. After they were sacrified, histopathological analyzeses were done. Nerve cohesiveness,nerve participation,SFI values,fibrosis and Scar Formation Index were statistically significant in Group 4 (p<0.05), fibroblasts and number of inflammatory cell were less in Group 3 according to other groups. However, in adhesion and axonal organization values,there were not statistically significant difference (p>0.05) . As a result, this work shows that peripheral nerve disconnection of hyaluronic acid (HA gel) and scar tissue in primary anastomosis model have positive effects in decreasing fibrosis. We think that the results which are taken from this work and the further investigations will have an application space in clinic practice.
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Keywords
Derive edilmiş yüksek molekül ağırlıklı hiyalüronik asid, Hiyalüronik asid, Periferik sinir, Skar formasyonu, Crosslinked high molecular weight hyaluronic acid, Hyaluronic acid, Peripheral nerve, Scar formation
Citation
Karaoğlu, A. (2015). Periferik sinir cerrahisi sonrası derive edilmiş yüksek molekül ağırlıklı hiyaluronik asidin perinöral skar formasyonuna olan etkisi:Deneysel çalışma. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.