Desouches C, Alluin O, Mutaftschiev N, Dousset E, Magalon G, Boucraut J, Feron F, Decherchi P
Service de Chirurgie de la Main, Chirurgie Plastique et Réparatrice des Membres, Assistance Publique, Hôpitaux de Marseille, Hôpital de la Conception, Marseille.
Rev Neurol (Paris). 2005 Nov;161(11):1045-59. doi: 10.1016/s0035-3787(05)85172-0.
Nerve injury compromises sensory and motor functions. Techniques of peripheral nerve repair are based on our knowledge regarding regeneration. Microsurgical techniques introduced in the late 1950s and widely developed for the past 20 years have improved repairs. However, functional recovery following a peripheral mixed nerve injury is still incomplete.
Good motor and sensory function after nerve injury depends on the reinnervation of the motor end plates and sensory receptors. Nerve regeneration does not begin if the cell body has not survived the initial injury or if it is unable to initiate regeneration. The regenerated axons must reach and reinnervate the appropriate target end-organs in a timely fashion. Recovery of motor function requires a critical number of motor axons reinnervating the muscle fibers. Sensory recovery is possible if the delay in reinnervation is short. Many additional factors influence the success of nerve repair or reconstruction. The timing of the repair, the level of injury, the extent of the zone of injury, the technical skill of the surgeon, and the method of repair and reconstruction contribute to the functional outcome after nerve injury.
This review presents the recent advances in understanding of neural regeneration and their application to the management of primary repairs and nerve gaps.
神经损伤会损害感觉和运动功能。周围神经修复技术基于我们对神经再生的认识。20世纪50年代末引入并在过去20年中广泛发展的显微外科技术改善了神经修复效果。然而，周围混合神经损伤后的功能恢复仍然不完全。
神经损伤后良好的运动和感觉功能取决于运动终板和感觉受体的再支配。如果细胞体在初始损伤中未能存活或无法启动再生，神经再生就不会开始。再生的轴突必须及时到达并重新支配适当的靶终末器官。运动功能的恢复需要一定数量的运动轴突重新支配肌纤维。如果再支配延迟时间短，感觉功能有可能恢复。许多其他因素影响神经修复或重建的成功。修复时机、损伤平面、损伤区域范围、外科医生的技术水平以及修复和重建方法都会影响神经损伤后的功能结局。
本综述介绍了神经再生研究的最新进展及其在一期修复和神经缺损处理中的应用。
