臺灣博碩士論文加值系統

在選用何種神經接合術來修補受損周邊神經時，其神經斷裂的長度是最重要的考慮因素。神經斷端接合及神經束接合法已經成功的應用於較短斷裂神經之修補，但當神經損傷太長而無法直接接合神經斷端時，神經自體移植法及神經管接合法便應運而生。因神經自體移植法並不會產生嚴重的組織反應，於是此種方法在各種神經接合術中為最佳選擇。但由於取得捐贈神經相當困難和為了避免在手術取得捐贈神經的過程中產生危險，於是利用人造神經管來修補斷裂神經成為另一選擇。
近年來許多研究均顯示電流及電磁對受損周邊神經的再生有促進的效果。同時對特定腧穴上施以針刺或電針刺激，亦對損傷神經再生有一定的幫助。唯以上所提文獻結果多以小斷裂神經之修補為研究目標，對臨床上常見之大截斷神經之修補助益不大。本實驗以矽膠製神經管對老鼠之截斷坐骨神經做一接合。同時對此截斷1 cm之神經斷端附近二腧穴施與針刺或電針刺激。我們的結果顯示傳統針刺或電針對大鼠截斷神經再生的成功率和只以矽膠管修補神經而不施以其他治療之對照組比較雖無明顯之差異，然而傳統針刺組對再生神經血管面積百分比及電針組之神經軸突密度、神經軸突面積百分比、再生血管數目、再生血管總面積、再生血管面積百分比和對照組比較，卻有明顯增加的現象(P<0.05)，說明了針刺對再生神經在組織上的恢復有顯著的的促進作用。

The gap length is the most important factor in deciding the method of nerve repair. End-to-end anastomosis and fascicular suturing have been successfully used to repair small defects between severed stumps. But it is not always possible to apply these methods to bridge large gaps. To overcome large gaps, nerve grafting and nerve bridge methods have been developed. The autograft is the best option to repair injured nerves because it will not cause severe tissue reaction during the implantation period. Nevertheless, disadvantages of the autograft include the difficulty of acquiring a donor nerve for grafting and the inevitable risks of surgery at another site. To solve these problems, artificial nerve cuffs or guide tubes are regraded as an alternative.
It has been showed that electric current and electromagnic fields can promote the regeneration of injured nerves. Also, traditional acupuncture and electroacupuncture exerted on certain acupuncture points have been demonstrated that they have positive effects on injured nerve. Due to the goal of previous studies was mainly to repair small defects between severed stumps, it is not practical for large gaps commonly seen in clinic. In this study, silicone rubber tubes were used to bridge 10-mm gaps in rat sciatic nerves and then traditional acupuncture or electroacupuncture were applied on two acupuncture points, which were near the ends of dissected nerve stumps. Results revealed that there was no statistical difference of success rate of nerve regeneration between traditional acupuncture/or electroacupuncture group and controls which were repaired with silicone rubber tubes only. However, the ratio of blood vessel areas to total nerve areas in the group of traditional acupuncture and the axonal density, the ratio of total axonal areas to endoneurium areas, the total blood vessel numbers, the areas of total blood vessels, the ratio of blood vessel areas to total nerve areas in the group of electroacupuncture were all significantly larger than those of the controls (P<0.05). The present study suggested that traditional acupuncture and electroacupuncture could promote the recovery of tissues in regenerated nerves.

目 錄
第一章、 前言1
第二章、 文獻探討3
一、神經系統介紹3
二、矽膠管內神經再生之細胞學變化11
三、各種神經修補技術14
四、可被當作神經管的材料16
五、刺激神經再生的方法18
六、坐骨神經介紹與取穴原則24
七、環跳穴(Huan Tiao) GB30的位置及功用25
八、陽陵泉(Yang Ling Chuan) GB34的位置及功用27
第三章、 材料與方法29
一、 材料29
二、 方法29
1、實驗動物模式29
2、實驗分組30
3、電生理檢測33
4、組織學定性分析(Qualitative histology)35
5、組織學定量分析(Quantitative histology)36
6、統計方法37
第四章、 結果38
一、 大白鼠外觀38
二、 矽膠管外觀41
三、 電生理檢測結果43
四、 切片觀察47
五、 神經再生的成功率53
六、 組織學定量分析54
第五章、討論63
第六章、結論67
參考文獻68
附錄80
英文摘要96
謝辭98

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