Sinir onarımında sütür sayısının iyileşmeye olan etkisi
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Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Epinöral sütürlerle onarım, sinir kesisi sonrası yapılan onarımda altın standart olarak kabul edilmektedir. Bu onarım metodunda sütür sayısı arttıkça sinir dokuya verilen ikincil hasar ve inflamasyon artmaktadır, bu nedenle iyileşme olumsuz etkilenmektedir. Sütür sayısı azalınca ise sinir onarım hattının mukavemeti azalmakla birlikte sinir uçlarında saçaklanmalar olmakta ve iyileşme olumsuz etkilenmektedir. Dolayısıyla atılan her bir ek sütürün, faydasının yanında zararı da bulunmaktadır ve bu durum cerrahları bir çıkmaza sokmaktadır. Bu çıkmazdan kurtulabilmek adına bu çalışma planlanmıştır. Toplam 70 adet Wistar Albino erkek sıçan randomize şekilde beş gruba ayrıldı. Gruplardan birisi kontrol grubu olarak bırakıldı ve cerrahi işlem yapılmadı. Diğer kalan dört gruptaki sıçanların sağ siyatik sinirlerine ise kesi sonrası sırasıyla iki, üç, dört ve altı sütür kullanılarak epinöral onarım yapıldı. Her gruptan altı sıçan randomize şekilde seçildi ve beşinci günün sonunda sakrifiye edildi. Bu sıçanlardan çıkartılan siyatik sinirlere biyomekanik olarak çekme testi uygulandı. Her gruptan kalan sekiz sıçan ise 12 haftalık takip sonrası duyu ve motor fonksiyonlara yönelik incelemelere tabi tutuldu. Ardından bu sıçanlara da sakrifikasyon uygulanarak çıkartılan sinirleri histolojik olarak incelendi. Çekme kuvvetlerine karşı dayanıklılıkta dört ve altı sütür atılan gruplar diğer sütür gruplarına üstün geldi. Ancak dört ve altı sütür atılan gruplar arasında dayanıklılık açısından anlamlı bir fark gözlenemedi. Fonksiyonel incelemelerde dört sütür atılan grupta genel olarak diğer sütür gruplarına kıyasla üstünlük sağlandığı görüldü. Histolojik incelemlerde altı sütür atılan grupta onarım hattındaki bağ dokusu indeksinin diğer sütür gruplarına kıyasla daha fazla olduğu görüldü. İki, üç ve dört sütür atılan gruplarda ise kendi aralarında anlamlı bir fark bulunamadı. Akson sayısı değişim indeksi açısından dört sütür ile onarımın iki ve altı sütürle onarıma üstünlük sağladığı ancak üç sütürle onarıma kıyasla anlamlı bir farklılık gösteremediği bulunmuştur. Akson çapı değişim indeksine göre hiçbir sütür grubu arasında fark saptanamamıştır. Bu sonuçlara göre dört sütürle onarımın hem dayanıklılığı hem de iyileşmeyi en iyi sağlayan epinöral onarım şekli olduğu düşünülmüştür. Bu bulgular hem klinik olarak benzer boyuttaki sinirlerin onarımına, hem de sıçan sinir çalışmalarının standartizasyonuna katkı sağlayacaktır. Sistematik olarak artan sayıda sütürle onarımın periferik sinirler üzerindeki etkisini biyomekanik, histolojik ve fonksiyonel olarak detaylı incelenmesi bakımından bu çalışma ilktir.
Epineural repair with sutures is accepted as the gold standard in nerve repair. In this repair method, when the number of sutures increases, secondary damage and inflammation to the nerve tissue increase, so nerve regeneration is negatively affected. When the number of sutures decreases, the strength of the nerve repair site decreases and nerve endings are fringed. Accordingly, the regeneration is negatively affected. Therefore, each additional suture is not only beneficial but also detrimental, which puts the surgeons in an impasse. This study has been designed in order to resolve this issue. A total of 70 Wistar Albino male rats were randomly divided into five groups. One of the groups was left as the control group and no surgical procedure was performed. Right sciatic nerves of the rats in the remaining four groups were repaired by using two, three, four and six epineural sutures, respectively, after the nerve transection. Six rats from each group were randomly selected and sacrificed at the end of the fifth day. Biomechanical testing was performed on the sciatic nerves collected from these rats. The remaining eight rats from each group were tested for sensory and motor functions after 12 weeks of follow-up. Then, these rats were also sacrificed and the nerves extracted from these rats were analyzed histologically. The groups with four and six sutures in resistance to tensile forces were superior to other suture groups. However, no significant difference was observed in terms of strength between the groups with four and six sutures. In functional examinations, it was observed that the group with four sutures was generally superior to the other suture groups. Histological analysis showed that the connective tissue index in the repair site was higher in the group with six sutures compared to the other suture groups. No significant difference was found between the groups with two, three and four sutures. In terms of axon number change index, it was found that repair with four sutures was superior to repair with two and six sutures, but did not show a significant difference compared to repair with three sutures. No difference was found between any of the suture groups according to the axon diameter change index. According to these results, it is thought that repair with four sutures is the best method of epineural repair that provides both strength and regeneration. These findings will contribute to both the repair of clinically similar nerves and the standardization of rat nerve studies. This study is the first to examine the effect of systematically increasing number of sutures on peripheral nerves in biomechanical, histological and functional parameters.
Epineural repair with sutures is accepted as the gold standard in nerve repair. In this repair method, when the number of sutures increases, secondary damage and inflammation to the nerve tissue increase, so nerve regeneration is negatively affected. When the number of sutures decreases, the strength of the nerve repair site decreases and nerve endings are fringed. Accordingly, the regeneration is negatively affected. Therefore, each additional suture is not only beneficial but also detrimental, which puts the surgeons in an impasse. This study has been designed in order to resolve this issue. A total of 70 Wistar Albino male rats were randomly divided into five groups. One of the groups was left as the control group and no surgical procedure was performed. Right sciatic nerves of the rats in the remaining four groups were repaired by using two, three, four and six epineural sutures, respectively, after the nerve transection. Six rats from each group were randomly selected and sacrificed at the end of the fifth day. Biomechanical testing was performed on the sciatic nerves collected from these rats. The remaining eight rats from each group were tested for sensory and motor functions after 12 weeks of follow-up. Then, these rats were also sacrificed and the nerves extracted from these rats were analyzed histologically. The groups with four and six sutures in resistance to tensile forces were superior to other suture groups. However, no significant difference was observed in terms of strength between the groups with four and six sutures. In functional examinations, it was observed that the group with four sutures was generally superior to the other suture groups. Histological analysis showed that the connective tissue index in the repair site was higher in the group with six sutures compared to the other suture groups. No significant difference was found between the groups with two, three and four sutures. In terms of axon number change index, it was found that repair with four sutures was superior to repair with two and six sutures, but did not show a significant difference compared to repair with three sutures. No difference was found between any of the suture groups according to the axon diameter change index. According to these results, it is thought that repair with four sutures is the best method of epineural repair that provides both strength and regeneration. These findings will contribute to both the repair of clinically similar nerves and the standardization of rat nerve studies. This study is the first to examine the effect of systematically increasing number of sutures on peripheral nerves in biomechanical, histological and functional parameters.
Açıklama
Anahtar Kelimeler
Standartizasyon, Standardization, Epinöral Onarım, Sinir İyileşmesi, Sütür Sayısı, Epineural Repair, Nerve Regeneration, Suture Number
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Eravşar, E. (2021). The impact of the number of sutures on regeneration in nerve repair. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
