Farklı periferal sinir anastomoz tekniklerinin sinir rejenerasyonu yönünden karşılaştırılmalı araştırılması
Date
2023-02-15
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Bursa Uludağ Üniversitesi
Abstract
Çalışmada farklı periferal sinir anastomoz tekniklerinin sinir rejenerasyonu yönünden karşılaştırılmalı araştırılması amaçlandı. Wistar Albino 56 adet sıçan kullanıldı. Epinöral dikiş (D) (GRI; n=21) ve doku yapıştırıcısı (FG) (GRII; n=21) olarak iki grupta planlandı. GRI-D’de D ile mikrocerrahi sinir anastomozu (MCSA) yapıldı. GRI-DP’de MCSA bölgesine PRP (trombositten zengin plazma) ve GRI-DM’de MKH (mezenkimal kök hücre) uygulandı. GRII-F’de FG ile sinir anastomozu yapıldı. GRII-FP’de FG ile anastomoz sonrası bölgeye PRP ve GRII-FM’de MKH uygulandı. Sıçanların pre- ve postoperatif 1’er hafta arayla 8. haftaya kadar nörolojik muayeneleri, yürüyüş analizleri ve elektromiyografileri (EMG) yapıldı. Sıçanlar 8. haftada sakrifiye edilerek nervus ischiadicus’ları histopatolojik olarak incelendi. Verilere istatistiksel analiz gerçekleştirildi. Postoperatif 8. haftada: duyusal fonksiyon tüm gruplarda aynıydı (p>0,05); fonksiyonel iyileşme GRI-DP’de en kötüydü ve sadece GRI-D ile GRI-DP arasındaki fark anlamlıydı (p=0,005); en yüksek amplitüd GRI-DM ve GRII-F’deydi; tüm gruplarda distal latans preoperatif değerlere ulaştı (p>0,05); ileti hızı için GRI-DP ile GRII-F arasında anlamlı fark görüldü (p=0,012); iğne EMG’de, musculus tibialis cranialis ve gastrocnemius’ta membran stabilitesi sağlandı (p>0,05); musculus tibialis cranialis’te GRI-D ile GRI-DP, GRI-DM ve GRII-FM arasında anlamlı fark vardı (p=0,019). Histopatolojide; GRI-D ile GRII-FM ve GRII-F ile GRII-FM arasında sadece inflamasyon yönünden anlamlı fark belirlendi (p=0,042, p=0,028). Nöroma en fazla GRI-D’deydi, ancak gruplar arasında anlamlı fark yoktu (p>0,05). Periferal sinir onarımında epinöral dikiş ve FG ile yapılan anastomoz etkili kaopitasyon sağlar. Duyusal ve motorik fonksiyonlardaki iyileşme, elektronörografi, iğne EMG ve histopatolojik veriler temelinde FG ile sinir anastomozu yapılan bölgeye MKH uygulanmasının daha etkin bir yöntem olduğu görülmektedir.
It was aimed to compare different peripheral nerve anastomosis techniques in terms of nerve regeneration. Wistar Albino 56 healthy rats were used. The study was planned as epineural suture (D) (GRI; n=21) and tissue adhesive (FG) (GRII; n=21). Microsurgical nerve anastomosis (MSNA) was performed with D in GRI-D. PRP was applied to the post-MSNA area in GRI-DP and MSC was applied in GRI-DM. In GRII-F, nerve anastomosis was performed with FG. PRP was applied to the post-anastomotic region with FG in GRII-FP and MSC was applied in GRII-FM. Neurological examinations, walking analysis and electromyography (EMG) of all rats were performed pre- and postoperatively at 1-week intervals until the 8 th week. At the 8th postoperative week, the rats were sacrificed and the nervus ischiadicus was examined histopathologically. Statistical analysis was performed on the data. At postoperative 8th week: sensory function was the same in all groups (p>0.05); functional improvement was worst in GRI-DP, and the difference was significant only between GRI-D and GRI-DP (p=0.005); the highest amplitude values were in GRI-DM and GRII-F, but only the difference between GRI-D and GRI-DP was significant (p=0.026). Distal latency values in all groups reached preoperative values (p>0.05); there was a difference between GRI-DP and GRII-F (p=0.012); in needle EMG, muscle membrane stability was achieved in the musculus tibialis cranialis and gastrocnemius (p>0.05), there was a significant difference between GRI-D and GRI-DP, GRI-DM and GRII-FM only in the musculus tibialis cranialis (p=0.019). Histopathologically, there was only a significant difference in term of inflammation between GRI-D and GRII-FM, and between GRII-F and GRII-FM (p=0.042, p=0.028). Neuroma was mostly in GRI-D, but there was no significant difference between groups (p>0.05). Anastomosis with epineural suture and FG provides effective kaopitation in peripheral nerve repair. Based on the improvement in sensory and motoric functions, electroneurography, needle EMG and histopathological data, local application of MSC to the region following nerve anastomosis with FG seems to be a more effective method in nerve injuries.
It was aimed to compare different peripheral nerve anastomosis techniques in terms of nerve regeneration. Wistar Albino 56 healthy rats were used. The study was planned as epineural suture (D) (GRI; n=21) and tissue adhesive (FG) (GRII; n=21). Microsurgical nerve anastomosis (MSNA) was performed with D in GRI-D. PRP was applied to the post-MSNA area in GRI-DP and MSC was applied in GRI-DM. In GRII-F, nerve anastomosis was performed with FG. PRP was applied to the post-anastomotic region with FG in GRII-FP and MSC was applied in GRII-FM. Neurological examinations, walking analysis and electromyography (EMG) of all rats were performed pre- and postoperatively at 1-week intervals until the 8 th week. At the 8th postoperative week, the rats were sacrificed and the nervus ischiadicus was examined histopathologically. Statistical analysis was performed on the data. At postoperative 8th week: sensory function was the same in all groups (p>0.05); functional improvement was worst in GRI-DP, and the difference was significant only between GRI-D and GRI-DP (p=0.005); the highest amplitude values were in GRI-DM and GRII-F, but only the difference between GRI-D and GRI-DP was significant (p=0.026). Distal latency values in all groups reached preoperative values (p>0.05); there was a difference between GRI-DP and GRII-F (p=0.012); in needle EMG, muscle membrane stability was achieved in the musculus tibialis cranialis and gastrocnemius (p>0.05), there was a significant difference between GRI-D and GRI-DP, GRI-DM and GRII-FM only in the musculus tibialis cranialis (p=0.019). Histopathologically, there was only a significant difference in term of inflammation between GRI-D and GRII-FM, and between GRII-F and GRII-FM (p=0.042, p=0.028). Neuroma was mostly in GRI-D, but there was no significant difference between groups (p>0.05). Anastomosis with epineural suture and FG provides effective kaopitation in peripheral nerve repair. Based on the improvement in sensory and motoric functions, electroneurography, needle EMG and histopathological data, local application of MSC to the region following nerve anastomosis with FG seems to be a more effective method in nerve injuries.
Description
Keywords
Elektromiyografi, Mezenkimal kök hücre, Periferal sinir anastomozu, Sinir rejenerasyonu, Trombositten zengin plazma, Electromyography, Mesenchymal stem cell, Peripheral nerve anastomosis, Nerve regeneration, Platelet rich plasma
Citation
Acar, H. (2023). Farklı periferal sinir anastomoz tekniklerinin sinir rejenerasyonu yönünden karşılaştırılmalı araştırılması. Yayınlanmamış doktora tezi. Bursa Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü.