S��anlarda sinir transeksiyon modelinde siyatik sinirin acil ve gecikmeli primer onar�m�

Tufan, Azmi; Karag�z G�zey, Feyza; Eren, Burak; Ta�, Abdurrahim; ��ler, Cihan; Akkalp, Asl� Kahraman; G�le�, ilker; Yayla, Vildan Ay�e; �abalar, Murat

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S��anlarda sinir transeksiyon modelinde siyatik sinirin acil ve gecikmeli primer onar�m� [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2020; 26(3): 361-365 | DOI: 10.14744/tjtes.2019.48579

S��anlarda sinir transeksiyon modelinde siyatik sinirin acil ve gecikmeli primer onar�m�

Azmi Tufan¹, Feyza Karag�z G�zey¹, Burak Eren¹, Abdurrahim Ta�², Cihan ��ler³, Asl� Kahraman Akkalp⁴, ilker G�le�¹, Vildan Ay�e Yayla⁵, Murat �abalar⁵
¹Sa�l�k Bilimleri �niversitesi, Ba�c�lar E�itim ve Ara�t�rma Hastanesi, N�ro�ir�rji Klini�i, �stanbul
²Sa�l�k Bilimleri �niversitesi, Gazi Ya�argil E�itim ve Ara�t�rma Hastanesi, N�ro�ir�rji Klini�i, Diyarbak�r
³�stanbul �niversitesi-Cerrahpa�a, Cerrahpa�a T�p Fak�ltesi, N�ro�ir�rji Anabilim Dal�, �stanbul
⁴�zmir Katip �elebi �niversitesi, Atat�rk E�itim ve Ara�t�rma Hastanesi, Patoloji Klini�i, �zmir
⁵Sa�l�k Bilimleri �niversitesi, Bak�rk�y Dr. Sadi Konuk E�itim ve Ara�t�rma Hastanesi, N�roloji Klini�i, �stanbul

AMA�: Periferik sinir yaralanmas�nda cerrahinin zamanlamas� hala tart��mal�d�r. Periferik sinir hasar�n�n derhal ve gecikmi� primer (yedi g�n sonra) onar�m�n�n sonu�lar� de�erlendirildi.
GERE� VE Y�NTEM: Wistar cinsi s��anlar 4 gruba ayr�ld�: Sinir keskin �ekilde Grup 1, 2 ve 4�te kesildi. Grup 1�de hemen dikildi ve Grup 2�de yedi g�n sonra dikildi ve Grup 4�te dikilmedi. Grup 3�te sol siyatik sinir sadece eksplore edildi. Sekiz hafta sonra, yaralanan sinir b�lgesinden doku �rnekleri al�nd�. Her iki gastrocnemius kaslar� tart�ld�. Sinir �rnekleri akson dejenerasyonu a��s�ndan incelendi. Miyelin vakuolizasyonu, akson d�zensizli�i ve �dem/enflamasyon parametreleri de�erlendirildi.
BULGULAR: Acil ve gecikmi� primer onar�m gruplar� aras�nda akson dejenerasyonu skoru ve gastrocnemius kas�n�n a��rl�� a��s�ndan anlaml� fark yoktu. Bununla birlikte, bu parametreler her iki tamir grubunda da kontrol grubundan anlaml� derecede daha iyiydi ve sinir kesisi yap�lmayan gruptan anlaml� derecede daha k�t�yd�.
TARTI�MA: S��anlarda siyatik sinir transeksiyon modelinde onar�m�n yakla��k bir hafta ge� yap�lmas� acil onar�m ile kar��la�t�r�ld��nda, kesilmi� sinirin uyard�� kas�n histolojik sonu�lar�n� ve a��rl��n� etkilememi�tir.

Anahtar Kelimeler: Operasyon zamanlamas�, periferik sinir; periferik sinir hasar�; sinir hasar�; iinir transeksiyonu.

Immediate versus delayed primary repair of the sciatic nerve in a nerve transaction model in rats

Azmi Tufan¹, Feyza Karag�z G�zey¹, Burak Eren¹, Abdurrahim Ta�², Cihan ��ler³, Asl� Kahraman Akkalp⁴, ilker G�le�¹, Vildan Ay�e Yayla⁵, Murat �abalar⁵
¹Department of Neurosurgery, Health Sciences University, Ba�c�lar Training and Research Hospital, �stanbul-Turkey
²Department of Neurosurgery, Health Sciences University, Gazi Ya�argil Training and Research Hospital, Diyarbak�r-Turkey
³Department of Neurosurgery, �stanbul University-Cerrahpa�a, Cerrahpa�a Faculty of Medicine, �stanbul-Turkey
⁴Department of Pathology, �zmir Katip �elebi University Atat�rk Training and Research Hospital, �zmir-Turkey
⁵Department of Neurology, Health Sciences University, Bakirk�y Dr. Sadi Konuk Training and Research Hospital, �stanbul-Turkey

BACKGROUND: The debate continues concerning surgical timing in a peripheral nerve injury. This study aims to evaluate the result of immediate versus delayed primary (after seven days) repair of peripheral nerve injury.
METHODS: In this study, Wistar rats were divided into four groups as follows: The nerve was sharply transected in Group 1, 2 and 4. It was immediately sutured in Group 1 and sutured seven days later in Group 2, and it was not sutured in Group 4. In Group 3, the left sciatic nerve was only explored. Eight weeks later, tissue samples were extracted from the injured nerve area. Both gastrocnemius muscles were weighed. The nerve samples were examined for axon degeneration. Myelin vacuolization, axon irregularity, and edema/inflammation parameters were evaluated.
RESULTS: There were not any significant differences in the score of axon degeneration and the weight of the gastrocnemius muscle between the immediate and delayed primary repair groups. However, these parameters were significantly better in both repair groups than to be in the control group and significantly worse than to be in the sham-operated group.
CONCLUSION: To delay the repair about one week did not affect the histological results and weight of the muscle that was innervated by the sectioned nerve comparing to be in the immediate repair in a sciatic nerve transaction model in rats.

Keywords: Nerve injury, nerve transaction; peripheral nerve; peripheral nerve injury; timing of the operation.

Sorumlu Yazar: Azmi Tufan, T�rkiye
Makale Dili: �ngilizce

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