肋間神經植入法治療臂神經叢撕裂傷之動物實驗

Animal Study on Intercostal Neurotization in Avulsion Brachial Plexus Injury

本實驗係以七條肋神經（T3-9），以顯微手術重建上臂之神經以治療臂神經叢之撕裂傷，共以十二隻台灣猴為實驗對象。術後每個月觀察評估其運動功能及肌電波之進步狀況。肌電波之研究發現所有動物術後均可再現運動單元電位。運動功能評估為肌肉強度0至4分之等級評分。術後六個月三角肌可進步至2.75，二頭肌可進步至2，三頭肌可進步至1.13，手內在肌進步至1.6。以HRP做組識學之神經線路追蹤檢查可以胸部脊髓之前角細胞，背神經節及交感神經節中發現。由本實驗可証明經以肋間神經重建臂神經叢後，於胸部脊髓內可建立傳入、傳出之神經迴路，而使得癱瘓上肢恢復部分運動功能。

Microsurgical reconstruction of brachial plexus was performed on twelve monkeys using the ipsilateral intercostal nerves (T3-9). Reinnervation of the individual nerves was evaluated monthly by observation of neuromuscular and electromyographic improvement. The electromyographic studies revealed the reappearance of motor unit potentials. According to a motor scale ranging from 0 to 4, the mean muscle power six months, after the operation had improved to 2.75 in the deltoid muscles, 2 in the biceps muscles, 1.22 in the triceps muscles, 1.13 in the flexor carpi radialis muscles, and 1.6 in the intrinsic muscles of the hands. Retrograde transport of horseradish peroxidase (HRP) from the neuromuscular junctions of the reconstructed musculocutanenus nerves at six months following a complete brachial plexus lesion in four animals demonstrated HRP-labeled neurons in the anterior horn, spinal ganglia and sympathetic ganglia of the thoracic spinal cord. It suggested that the regenerated afferent and efferent circuits in the thoracic cord innervating the transected brachial plexuses were able to generate some movement in the paralyzed upper limbs.