Lohmeyer J, Zimmermann S, Sommer B, Machens H-G, Lange T, Mailänder P
Abteilung für Plastische, Hand- und Wiederherstellungschirurgie, Intensiveinheit für Schwerbrandverletzte, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck.
Chirurg. 2007 Feb;78(2):142-7. doi: 10.1007/s00104-006-1269-1.
The nerve autograft is the gold standard for the reconstruction of peripheral nerve defects. In short gaps, nerve repair by means of tubulization has become an alternative. This technique is discussed based on the current literature and our own experience.
Nerve reconstruction by means of tubulization was performed in 11 patients. Nerve gaps in the hand of up to 18 mm were reconstructed. Sensibility was assessed using static and dynamic two point discrimination (s-, d2PD) and monofilament testing 3, 6 and 12 months postoperatively.
Three out of 11 patients complained of a temporary foreign body sensation in the area of the implant; this was persistent in one case. Four out of six patients showed excellent results with s2PD of <or=7 mm (Highet S4) assessed 12 months postoperatively. One patient regained no (s2PD>15 mm, S0), another poor sensibility (s2PD 15 mm, S3). D2PD and monofilament testing confirmed these results.
Nerve reconstruction by means of tubulization seems to be a suitable method for certain indications in the reconstruction of short defects of digital and palmar nerves. Donor site morbidity can be avoided. Similarly to nerve transplantation, the operation requires microsurgical skills.
神经自体移植是修复周围神经缺损的金标准。对于短距离缺损，通过管道化进行神经修复已成为一种替代方法。本文根据当前文献及我们自己的经验对该技术进行讨论。
对11例患者采用管道化方法进行神经重建。重建手部长达18毫米的神经缺损。术后3、6和12个月，使用静态和动态两点辨别觉（s-、d2PD）及单丝测试评估感觉功能。
11例患者中有3例在植入区域主诉有暂时的异物感；其中1例持续存在。6例患者中有4例术后12个月s2PD≤7毫米（希格特S4），结果极佳。1例患者无恢复（s2PD>15毫米，S0），另1例感觉功能恢复差（s2PD 15毫米，S3）。D2PD和单丝测试证实了这些结果。
对于修复指神经和掌神经的短距离缺损，管道化神经重建似乎是一种适用于特定适应证的方法。可避免供区并发症。与神经移植类似，该手术需要显微外科技术。
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