Rovak J M, Cederna P S, Kuzon W M
Duke University School of Medicine, Durham, North Carolina, USA.
J Reconstr Microsurg. 2001 Nov;17(8):615-24. doi: 10.1055/s-2001-18817.
Terminolateral neurorrhaphy (TLN) is an experimental technique for repairing peripheral nerves, when the proximal cut nerve stump is not available for traditional end-to-end repair. Over the past 7 years, the efficacy of TLN, its ability to preserve donor nerve function, the necessity of disrupting donor nerve connective tissue layers during the procedure, the mechanism by which TLN affords reinnervation, and the definition of the procedure, have been debated. In this critical review of TLN literature, the authors attempt to demonstrate 1) that a TLN in which the surgeon deliberately transects donor nerve axons is an effective method for peripheral nerve repair; the mechanisms by which axons innervate target muscles following this procedure are well-defined, and there is adequate experimental and clinical evidence to support its clinical application; and 2) that a TLN procedure in which the surgeon attempts to leave the donor nerve intact is neither mechanistically distinct from a TLN with deliberate donor nerve axotomy, nor is it as efficacious. Future studies should assess the degree of donor nerve transection that will maximize reinnervation via the TLN graft, without incurring functionally significant donor nerve deficits.
端侧神经缝合术（TLN）是一种用于修复周围神经的实验性技术，当近端切断的神经残端无法进行传统的端端修复时使用。在过去7年里，端侧神经缝合术的疗效、保留供体神经功能的能力、手术过程中破坏供体神经结缔组织层的必要性、端侧神经缝合术实现神经再支配的机制以及该手术的定义等问题一直存在争议。在这篇对端侧神经缝合术文献的批判性综述中，作者试图证明：1）外科医生故意横断供体神经轴突的端侧神经缝合术是一种有效的周围神经修复方法；在此手术后轴突支配目标肌肉的机制已明确，并且有足够的实验和临床证据支持其临床应用；2）外科医生试图使供体神经保持完整的端侧神经缝合术，在机制上与故意进行供体神经轴突切断的端侧神经缝合术并无不同，且效果也不如后者。未来的研究应评估供体神经横断的程度，以在不造成功能上显著的供体神经缺损的情况下，通过端侧神经缝合术移植物实现最大程度的神经再支配。
