【作者】 张猛；

【导师】 张键； 陈统一； 陈增淦；

【作者基本信息】 复旦大学 ， 外科学， 2009， 硕士

【摘要】 背景:坐骨神经损伤后的治疗和康复是创伤外科的重点研究课题。坐骨神经损伤后,不论采用何种神经修复技术,基本目的均在于准确对合原先的神经束或功能相同的神经束,创造再生轴突抵达适宜末梢器官、恢复功能的最佳条件。但在临床实践中,神经损伤治疗的效果不甚理想,重要原因就是同一功能神经束的远近端不能准确缝接所致的运动或感觉神经纤维之间错向生长。因此构建坐骨神经内部神经束和束组的三维结构,了解其交叉重组的规律对治疗坐骨神经损伤具有重要临床意义。目的:按序提取并处理经乙酰胆碱酯酶染色的新鲜人尸坐骨神经连续组织切片的二维图像数字信息,通过3D-Nerve软件系统对坐骨神经内部显微结构进行三维可视化研究。方法:取自愿捐献尸体右侧坐骨神经1例,以头发为标记物,OCT包埋、液氮速冻固定后做连续组织切片,乙酰胆碱酯酶染色,高分辨率扫描仪依序获取坐骨神经二维图像信息,应用自行开发的3D-Nerve软件系统重建坐骨神经内部神经束的三维结构。结果:人体坐骨神经在不同断面神经束的数目、大小、形态及性质不断变化,在近侧断面神经束间频繁交叉重组,远侧断面的交叉重组较少。3D-Nerve软件可清晰显示坐骨神经各断面的二维显微结构,并能重建坐骨神经内部神经束及束组的三维立体图像,还可从不同角度观察神经束间的交叉重组情况。结论:通过3D-Nerve软件系统可较准确形象地显示人体坐骨神经任意断面的二维显微结构信息以及三维立体行径,提供了一种坐骨神经内部显微结构三维可视化的有效方法,为医学生及临床医师了解坐骨神经内部显微结构提供参考,对坐骨神经损伤后修复方式的选择有一定指导意义。更多还原

【Abstract】 Background:The healing and rehabilitation after sciatic nerve injuries are one of the intensive topics in traumatic surgery.No matter what reparative technology is applied,the basic destination is to suture the original nerve-tracts,to restore identical function ones and to create the optimum conditions for regenerated axis cylinders reaching the peripheral organs and functional recovery.But in clinical practice,the effect is not quite ideal.The considerable agent is that the distal and proximal end of funiculi with identical functions can’t be accurately sutured,which lead to irregular accretion in nerve fibres.So constructing the three -dimensional microstructure of nerve-tracts in sciatic nerves and comprehending the decussate and custom-crafted regularity have very important clinical significances.Objective:The two-dimensional human sciatic nerve image information of series freezing tissue sections stained with Ache was acquired ordinally, then the three-dimensional visualization of the sciatic nerve was investigated with 3D-Nerve software systems.Methods:One fresh sciatic nerve specimen was dissected,tagged with female hairs and embedded in OCT.Series freezing tissue sections were made,stained with AChe histochemically,acquired the two-dimensional imageinformation through high resolution scanner.Finally, three-dimensional microstructure was reconstructed with 3D-nerve software.Results:The number,size,form and pattern of the sciatic nerve funiculi vary continually in different transverse sections.The funiculi unit divides frequently at some proximal transverse sections while there are rarely changes at the distal levels.The microstructure of the nerve funiculi is displayed distinctly at different transverse sections and three-dimensional images was reconstructed with 3D-nerve software system.In addition,we can observe them in different angles.Conclusions:The two-dimensional and three-dimensional microstructure of the funiculi of human sciatic nerve were clearly reconstructed with 3D-nerve,which might provide an effective method for three-dimensional visualization of sciatic nerve and supply references to understand the microstructure of sciatic nerve for medical students and surgeons.It is also useful for the repairing process of sciatic nerve injury by providing the precise regional anatomic structure atlas of the nerve.更多还原