Sıçanlarda vaskülarize pediküllü jejunum konduitinin periferik sinir sistemi rejenerasyonlarında etkinliğinin değerlendirilmesi
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Dosyalar
Tarih
2021
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Periferik sinir sistemi yaralanmalarında çözülmesi gereken problemler arasında rejenerasyonun tam sağlanamamasının yanı sıra, defektli olguların yönetiminde ortaya çıkan zorluklar yer almaktadır. Her iki problem yüz yıllardır araştırılmakta olup birçok tedavi stratejisi sunulmasına rağmen, elde edilen veriler mevcut problemleri ortadan kaldırmaya yetmemektedir. Sinir defektlerinin onarımında sinir kondüitlerinin geniş kullanım alanı mevcut olup genellikle biyolojik ve sentetik kondüitlerin greft şeklinde uygulanımı sunulmaktadır. Bu çalışmada, sıçanlarda pediküllü jejunum flebinin siyatik sinir rejenerasyonu üzerine etkinliğini değerlendirmeyi amaçladık. Bu çalışma, her grupta 10 (n=10) sıçan olmak üzere 9 grup oluşturularak 90 sıçan üzerinde gerçekleştirildi. Grup 1: Sham grubu- defektsiz sinir onarımı; Grup 2: Sinir grefti grubu- eksize edilen 1 cm'lik sinir segmenti ters çevrilerek sinir grefti şeklinde defekt alana tekrar koapte edildi; Grup 3: Ven greftli onarım grubu- sağ eksternal juguler venden alınan 1 cm'lik ven grefti ters çevrilerek sinir defekt alana koapte edildi ; Grup 4: Jejunum kondüitli defektli sinir onarımı grubu- abdominal alandan transfer edilen 2 cm'lik pediküllü jejunum segmenti siyatik sinirde oluşturulan 1 cm'lik defekt alana adapte edildi; Grup 5: Jejunum kondüitli defektsiz sinir onarımı grubu- abdominal alandan transfer edilen 2 cm'lik pediküllü jejunum segmenti primer epinöral onarılmış siyatik sinir etrafına sarıldı; Grup 6: Jejunum kondüitli sinir grefti grubu- abdominal alandan transfer edilen 2 cm'lik pediküllü jejunum segmenti,siyatik sinirden eksize edilen 1 cm'lik sinir segmenti ters çevrilerek sinir grefti şeklinde yerleştirildikten sonra onarım sahası etrafına sarıldı; Grup 7: Mukozasız jejunum kondüitli defektli sinir onarımı grubu- abdominal alandan transfer edilen 2 cm'lik pediküllü jejunum segmenti mukoza rezeksiyonu sonrasında siyatik sinirde oluşturulan 1 cm'lik defekt alana adapte edildi; Grup 8: Mukozasız jejunum kondüitli defektsiz sinir onarımı grubu- abdominal alandan transfer edilen 2 cm'lik pediküllü jejunum segmenti mukoza rezeksiyonu sonrasında primer onarım sahası etrafına sarıldı ; Grup 9: Mukozasız jejunum kondüitli sinir grefti grubu-abdominal alandan transfer edilen 2 cm'lik pediküllü mukozasız jejunum segmenti, siyatik sinirden eksize edilen 1 cm'lik sinir segmenti ters çevrilerek sinir grefti şeklinde yerleştirildikten sonra onarım sahası etrafına sarıldı. Cerrahi işlemleri takip eden 2.ayda sıçanlara yürüme testi yapılarak Siyatik Fonksiyon İndeks (SFI)' leri hesaplandı. Sıçanlar sakrifiye edildikten sonra onarılan sinirlerden alınan örnekler histopatolojik incelemelerle değerlendirildi. Yürüme testi sonuçları sırasıyla: Grup 1: -101.399, Grup 2: -92.780, Grup 3: -74.780, Grup 4: -93.849, Grup 5: -90.878, Grup 6: -91.58, Grup 7: -71.445, Grup 8: -78.1981, Grup 9: -54.942 şeklinde hesaplandı. Bu değerlendirmeye göre 0-100 arasında değerler elde edilmekte olup 0'a yakın değerler fonksiyonel iyi sonuçları göstermektedir. Mukoza rezeksiyonlu jejunum kondüiti uygulanan gruplar (Grup 7,8 ve 9) SFI açısından istatistiksel anlamlı sonuçlar gösterdi. Histopatolojik parametrelerin grup içindeki ortalamaları ele alınarak gerçekleştirilen karşılaştırmalarda jejunum kondüiti ile onarım uygulanan gruplarda bütün parametreler açısından olumsuz değerlerle karşılaşıldı. Mukoza rezeksiyonu sonrasında jejunum kondüiti uygulanan gruplarda ise anlamlı fark aksonal dejenerasyon, akson yoğunluğu, myelinizasyon ve disorganizasyon parametrelerinde görüldü. Sonuç olarak, bu çalışmada pediküllü jejunum flebinin mukoza rezeksiyonu sonrasında sinir onarım sahasına yerleştirilmesinin rejenerasyon etkinliğini fonksiyonel ve histopatolojik açıdan arttırdığını deneysel model üzerinde gösterdik. Periferik sinir yaralanmalarında tübüler paterne sahip otojen dokunun vaskülarize kondüit flebi şeklinde klinik uygulanmasının rejenerasyon üzerine olumlu katkıları ileri araştırmalarla gösterilebilir.
Regeneration following nerve injury is still among the unsolved problems of peripheral nerve surgery; so is management of defective cases. Both of the problems have been investigating for centuries and a great number of treatment strategies have been presented however none of them has overcome the aforementioned issues. Nerve conduits have a broad spectrum of usage İn the repair of nerve defects, and to the best of our knowledge, the application of biological and synthetic conduits is generally executed in the form of graft. In this study, we aimed to evaluate the effects of pedicled jejunal flap on rat sciatic nerve regeneration. A total of 90 rats were divided into 9 groups randomly, 10 rat in each (n=10). Group 1: sham group- primary nerve repair; Group 2: Nerve graft group- following excision of a 1 cm nerve segment it was placed to the same gap in opposite direction; Group 3: Vein graft group- 1 cm vein graft obtained from the right external jugular vein was placed between the distal and proximal nerve segments of sciatic; Group 4: Defective nerve repair group with jejunal conduit- a 2 cm pedicled jejunal segment was transferred from intraabdominal area and placed to the 1 cm gap area of sciatic nerve. Group 5: Primary nerve repair group with jejunal conduit- a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the sciatic nerve coaptation area. Group 6: Nerve graft group with jejunal conduit- a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the coaptation areas of distal and proximal segments with a 1 cm nerve graft. Group 7: Defective nerve repair group with mucosa resected jejunal conduit- following the mucosal resection procedure a 2 cm pedicled jejunal segment was transferred from intraabdominal area and placed to the 1 cm gap area of sciatic nerve. Group 8: Primary nerve repair group with mucosa resected jejunal conduit- following the mucosal resection procedure a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the sciatic nerve coaptation area. Group 9: Nerve graft group with mucosa resected jejunal conduit- following the mucosal resection procedure a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the coaptation areas of distal and proximal segments with a 1 cm nerve graft. Walking track analysis was performed to the rats at the end of 2 months period and SFI (Sciatic Function Index) was calculated. Examples took from the rats following the sacrifice were assessed regarding to histopathological parameters. SFI results were as follows: Group 1: -101.399, Group 2: -92.780, Group 3: -74.780, Group 4: -93.849, Group 5: -90.878, Group 6: -91.58, Group 7: -71.445, Group 8: -78.1981, and Group 9: -54.942. According to this index, values close to 0 are found to be better results. Significant differences were revealed between the mucosa resected jejunal conduit applied groups (Group7,8,and 9) and the others in terms of SFI. According to comparison of mean values of histopathological parameters, unfavorable results of jejunal conduit applied groups were observed in all of them. Significant differences of axonal degeneration, axonal density, myelinization and disorganization parameters were found out in mucosa resected jejunal conduit applied groups. Consequently, in this experimental study, we demonstrated that pedicled jejunal conduits after resection of mucosa facilitated regeneration of sciatic nerve both functionally and histopathologically. Furhter clinical studies investigating the effects of pedicled autogenous tubular tissues on peripheral nerve regeneration can contribute to the literature.
Regeneration following nerve injury is still among the unsolved problems of peripheral nerve surgery; so is management of defective cases. Both of the problems have been investigating for centuries and a great number of treatment strategies have been presented however none of them has overcome the aforementioned issues. Nerve conduits have a broad spectrum of usage İn the repair of nerve defects, and to the best of our knowledge, the application of biological and synthetic conduits is generally executed in the form of graft. In this study, we aimed to evaluate the effects of pedicled jejunal flap on rat sciatic nerve regeneration. A total of 90 rats were divided into 9 groups randomly, 10 rat in each (n=10). Group 1: sham group- primary nerve repair; Group 2: Nerve graft group- following excision of a 1 cm nerve segment it was placed to the same gap in opposite direction; Group 3: Vein graft group- 1 cm vein graft obtained from the right external jugular vein was placed between the distal and proximal nerve segments of sciatic; Group 4: Defective nerve repair group with jejunal conduit- a 2 cm pedicled jejunal segment was transferred from intraabdominal area and placed to the 1 cm gap area of sciatic nerve. Group 5: Primary nerve repair group with jejunal conduit- a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the sciatic nerve coaptation area. Group 6: Nerve graft group with jejunal conduit- a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the coaptation areas of distal and proximal segments with a 1 cm nerve graft. Group 7: Defective nerve repair group with mucosa resected jejunal conduit- following the mucosal resection procedure a 2 cm pedicled jejunal segment was transferred from intraabdominal area and placed to the 1 cm gap area of sciatic nerve. Group 8: Primary nerve repair group with mucosa resected jejunal conduit- following the mucosal resection procedure a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the sciatic nerve coaptation area. Group 9: Nerve graft group with mucosa resected jejunal conduit- following the mucosal resection procedure a 2 cm pedicled jejunal segment was transferred from intraabdominal area and wrapped the coaptation areas of distal and proximal segments with a 1 cm nerve graft. Walking track analysis was performed to the rats at the end of 2 months period and SFI (Sciatic Function Index) was calculated. Examples took from the rats following the sacrifice were assessed regarding to histopathological parameters. SFI results were as follows: Group 1: -101.399, Group 2: -92.780, Group 3: -74.780, Group 4: -93.849, Group 5: -90.878, Group 6: -91.58, Group 7: -71.445, Group 8: -78.1981, and Group 9: -54.942. According to this index, values close to 0 are found to be better results. Significant differences were revealed between the mucosa resected jejunal conduit applied groups (Group7,8,and 9) and the others in terms of SFI. According to comparison of mean values of histopathological parameters, unfavorable results of jejunal conduit applied groups were observed in all of them. Significant differences of axonal degeneration, axonal density, myelinization and disorganization parameters were found out in mucosa resected jejunal conduit applied groups. Consequently, in this experimental study, we demonstrated that pedicled jejunal conduits after resection of mucosa facilitated regeneration of sciatic nerve both functionally and histopathologically. Furhter clinical studies investigating the effects of pedicled autogenous tubular tissues on peripheral nerve regeneration can contribute to the literature.
Açıklama
Anahtar Kelimeler
Sıçan, Periferik sinir sistemi, Vaskülarize pediküllü jejunum konduitini, Rat, Peripheral nervous system, Vascularized pedicled jejunal conduit
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
İsmayilzade, M. (2021). Sıçanlarda vaskülarize pediküllü jejunum konduitinin periferik sinir sistemi rejenerasyonlarında etkinliğinin değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Plastik Cerrahi Anabilim Dalı, Konya.
