Sıçanlarda vaskülerize tuba uterina tubuler flebinin periferik sinir sistemi rejenerasyonlarında etkinliğinin değerlendirilmesi
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Sinir defektlerinde, donör alan morbiditesi ve elde edilecek sinir greftinin sınırlı ölçüde olması sinir grefti ile onarım yöntemin en önemli handikaplarıdır. Bu nedenle, sinir kondüitleri periferik sinir sistemi yaralanmalarında primer onarımın mümkün olmadığı durumlarda kullanılabilir.Bu çalışmanın amacı pediküllü tuba uterina tübüler flebinin periferik sinir sistemi rejenerasyonlarında etkinliklerinin araştırılmasıdır. Bu çalışma her bir grupta (6 grup) 10 adet Wistar- Albino cinsi 14-16 haftalık toplam 60 adet dişi sıçan üzerinde gerçekleştirildi. 1. Grup: Sham grubu, 2. Grup: Sinir grefti; 1 cm'lik siyatik sinir segmenti kesilerek tekrar aynı yerine koapte edildi, 3. Grup: Tuba uterina flebi, doğru yön; Tuba uterinanın over - uterus yönü doğru yön olarak kabul edildi ve flep sinir kondüiti olarak proksimal – distal yönde yerleştirildi, 4. Grup: Tuba uterina flebi, ters yön; Flep, Grup 3'ün ters yönünde yerleştirildi, 5. Grup: Tuba uterina grefti, doğru yön: Tuba uterina segmenti kendisini besleyen pedikülden tamamen ayrılarak greft şeklinde kaldırıldı ve defekt alana yerleştirildi, 6. Grup: Tuba uterina grefti, ters yön: Grup 5'in tersi yönünde yerleştirildi. Cerrahi işlemler sonrası 3 ay süreyle sıçanlar takip edildi. Bu sürenin sonunda yürüme testi ile Siyatik Fonksiyon İndeksi (SFI) hesaplanarak ve EMG ile değerlendirme, ışık ve elektron mikroskobisi ile değerlendirme yapılarak grupların sinir rejenerasyonlarındaki etkileri karşılaştırıldı. Yürüme testinde değerlendirilen SFI sırasıyla: Grup 1'de 76.23, Grup 2'de 36.1 , Grup 3'te 52.75, Grup 4'te 51.79, Grup 5'te 45.54, Grup 6'da 46.79 olarak hesaplandı. Bu indekse göre 0-100 arasında değerlendirilme yapılmaktadır ve 0'a yakın değerler fonksiyonal olarak daha iyi sonuçlardır. EMG sonuçlarında ise Grup 5 ve Grup 6'da ki CMAP ve CMAP eğrileri altında kalan alanlar Grup 3 ve 4' e göre fazlaydı, ancak Grup 2'ye göre daha düşüktü. 8 Işık mikroskobisinde ise Grup 5'te düzenli sinir iyileşmesi ortalama skoru 2.2, Grup 6'da 2,4, Grup 3'te 1,3, Grup 4'te 1,2'ydi. Grup 2'de ise bu değer 2,7'du. Grup 1'de herhangi bir rejenerasyon gözlenmedi. Fibrozis, inflamasyon ve vaskülarite Grup 5 ve 6'da benzer olup, Grup 2'den yüksek, Grup 3 ve 4'ten düşüktü. Sinir alanından elde edilen TEM kesitleri ultrayapısal olarak değerlendirildiğinde Grup 2'de aksonlar organize ve koyu boyanmış, sağlıklı bir morfolojide izlenirken, myelinize sinir sayısı diğer gruplardan daha fazlaydı. Grup 5 ve 6'ya ait TEM mikrografları, miyelin ve akson yapılarının oldukça düzenli ve kan damarlarının bol bulunduğunu gösterdi ve Grup 3 ve 4'e göre myelinize sinir sayımı daha fazlaydı. Ayrıca, Grup 3 ve 4'te tuba uterinadaki lümen epitel hücreleri ise Grup 5 ve 6'dakilere kıyasla daha organize ve sağlıklı bir morfolojide izlendi. Grup 5 ve 6 ile Grup 3 ve 4'e ait ultrayapısal bulgular kendi aralarında benzer bir morfoloji sergiledi. Sonuç olarak, çalışmamızda tuba uterina tübüler kondüitinin greft olarak aktarılmasının flep olarak aktarılmasına göre sinir rejenerasyonu üzerine etkisinde daha başarılı olduğu ve silyalı yapıların yönünün bu sonuç üzerinde anlamlı etkilerinin olmadığı saptandı.
In nerve defects, donor site morbidity and limited nerve graft are the most important handicaps of nerve graft repair. Therefore, nerve conduits can be used in cases where primary repair is not possible in peripheral nervous system injuries. The aim of this study is to investigate the efficacy of pedicular tuba uterine tubular flap in peripheral nervous system regeneration. This study was performed on a total of 60 female rats, who were 14-16 weeks old Wistar- Albino Rats. 60 female rats were divided 6 groups. Group 1: Sham group, Group 2: Nerve graft; The sciatic nerve segment of 1 cm was cut and coaptated to the same site again. Group 3: Tuba uterine flap, right direction; Ovarian - uterine direction of the uterus was accepted as the right direction and flap was placed proximal - distal as nerve conduit, Group 9 4: Tuba uterine flap, reverse direction; The flap was placed in the opposite direction of Group 3, Group 5: Tuba uterine graft, right direction: The tubal uterine segment was completely removed from the pedicle feeding itself and placed in the defect area. Group 6: Tuba uterine graft, reverse direction: Group 5 in the opposite direction. The rats were followed up for 3 months after the surgical procedures. At the end of this period, the effects of the groups on nerve regeneration were compared by calculating the Sciatic Function Index (SFI) by walking test and EMG evaluation, light and electron microscopy. SFI was evaluated as 76.23 in Group 1, 36.1 in Group 2, 52.75 in Group 3, 51.79 in Group 4, 45.54 in Group 5, and 46.79 in Group 6, respectively. According to this index, it is evaluated between 0-100 and values closer to 0 are functionally better results. In the EMG results, the areas under CMAP and CMAP curves in Group 5 and Group 6 were more than Group 3 and 4, but were lower than Group 2. According to evaluation of the light microscopy, the mean score of nerve regeneration was 2.2 in Group 5, 2.4 in Group 6, 1.3 in Group 3, and 1.2 in Group 4. In group 2, this value was 2.7. No regeneration was observed in Group 1. Fibrosis, inflammation and vascularity were similar in Groups 5 and 6, higher than Group 2, and lower than Groups 3 and 4. When the TEM sections obtained from the nerve area were evaluated ultrastructively, the axons were observed in an organized and dark stained, healthy morphology in Group 2, whereas the number of myelinized nerves was higher than the other groups. TEM micrographs of groups 5 and 6 showed that myelin and axon structures were fairly regular and blood vessels were abundant, and myelinized nerve count was higher than Groups 3 and 4. In addition, the luminal epithelial cells in the tuba uterine in Groups 3 and 4 were observed in a more organized and healthy morphology than in Groups 5 and 6. The ultrastructural findings of Groups 5 and 6, and Groups 3 and 4 showed a similar morphology each other. In conclusion, it was found that tubular uterine tubular conduit as a graft was more 10 successful in the effect on nerve regeneration than transferring as a flap and the direction of ciliated structures had no significant effect on this result.
In nerve defects, donor site morbidity and limited nerve graft are the most important handicaps of nerve graft repair. Therefore, nerve conduits can be used in cases where primary repair is not possible in peripheral nervous system injuries. The aim of this study is to investigate the efficacy of pedicular tuba uterine tubular flap in peripheral nervous system regeneration. This study was performed on a total of 60 female rats, who were 14-16 weeks old Wistar- Albino Rats. 60 female rats were divided 6 groups. Group 1: Sham group, Group 2: Nerve graft; The sciatic nerve segment of 1 cm was cut and coaptated to the same site again. Group 3: Tuba uterine flap, right direction; Ovarian - uterine direction of the uterus was accepted as the right direction and flap was placed proximal - distal as nerve conduit, Group 9 4: Tuba uterine flap, reverse direction; The flap was placed in the opposite direction of Group 3, Group 5: Tuba uterine graft, right direction: The tubal uterine segment was completely removed from the pedicle feeding itself and placed in the defect area. Group 6: Tuba uterine graft, reverse direction: Group 5 in the opposite direction. The rats were followed up for 3 months after the surgical procedures. At the end of this period, the effects of the groups on nerve regeneration were compared by calculating the Sciatic Function Index (SFI) by walking test and EMG evaluation, light and electron microscopy. SFI was evaluated as 76.23 in Group 1, 36.1 in Group 2, 52.75 in Group 3, 51.79 in Group 4, 45.54 in Group 5, and 46.79 in Group 6, respectively. According to this index, it is evaluated between 0-100 and values closer to 0 are functionally better results. In the EMG results, the areas under CMAP and CMAP curves in Group 5 and Group 6 were more than Group 3 and 4, but were lower than Group 2. According to evaluation of the light microscopy, the mean score of nerve regeneration was 2.2 in Group 5, 2.4 in Group 6, 1.3 in Group 3, and 1.2 in Group 4. In group 2, this value was 2.7. No regeneration was observed in Group 1. Fibrosis, inflammation and vascularity were similar in Groups 5 and 6, higher than Group 2, and lower than Groups 3 and 4. When the TEM sections obtained from the nerve area were evaluated ultrastructively, the axons were observed in an organized and dark stained, healthy morphology in Group 2, whereas the number of myelinized nerves was higher than the other groups. TEM micrographs of groups 5 and 6 showed that myelin and axon structures were fairly regular and blood vessels were abundant, and myelinized nerve count was higher than Groups 3 and 4. In addition, the luminal epithelial cells in the tuba uterine in Groups 3 and 4 were observed in a more organized and healthy morphology than in Groups 5 and 6. The ultrastructural findings of Groups 5 and 6, and Groups 3 and 4 showed a similar morphology each other. In conclusion, it was found that tubular uterine tubular conduit as a graft was more 10 successful in the effect on nerve regeneration than transferring as a flap and the direction of ciliated structures had no significant effect on this result.
Açıklama
Anahtar Kelimeler
Fallop tüpleri, Fallopian tubes, Hayvan deneyleri, Animal experimentation, Periferik sinir hasarları, Peripheral nerve injuries
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yıldırım, M. E. C. (2019). Sıçanlarda vaskülerize tuba uterina tubuler flebinin 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.
