Sinis Nektarios, Haerle Max, Becker Stephan Thomas, Schulte-Eversum Caterina, Vonthein Reinhard, Rösner Harald, Schaller Hans-Eberhard
Klinik für Plastische, Hand, Rekonstruktive, und Verbrennungschirurgie, Universität Tübingen, BG-Unfallklinik, Tübingen, Germany.
Plast Reconstr Surg. 2007 Mar;119(3):960-6. doi: 10.1097/01.prs.0000242486.70919.82.
The purpose of this study was to investigate neuroma formation in a rat median nerve model.
In three groups, the median nerve was exposed and a gap was created. In the first group, a short gap of 1 cm (n = 12) was created; in the second, a long gap of 2 cm (n = 12) was created in the nerve. Another group was used to analyze the development of neuroma formation when the proximal stump was buried in adjacent muscle with an additional gap of 2 cm (n = 12). The use of different lengths should allow one to gain information about dilution effects of distal stump factors that may contribute to neuroma formation. Nine months later, specimens were gathered and histologically analyzed. The cross-sectional areas of neuromas were measured and the neural/connective tissue ratios were estimated.
The cross-sectional areas demonstrated that neuroma formation was significantly higher in the short-gap group than in the long-gap group, and smallest in the muscle-covered group. The percentage of neural tissue was highest in the muscle-covered and long-gap groups and lowest in the short-gap group.
These results demonstrate an association between neuroma formation and distal stump distance. This observation may be explained by the factors originating from the distal stump that were blocked when the proximal nerve stump was completely buried in the muscle. For clinical application, the authors recommend not only burying the proximal stump in a muscle but also surgically augmenting the gap between the proximal and distal stumps.
本研究的目的是在大鼠正中神经模型中研究神经瘤的形成。
将三组大鼠的正中神经暴露并制造间隙。第一组制造1厘米的短间隙（n = 12）；第二组在神经中制造2厘米的长间隙（n = 12）。另一组用于分析当近端残端埋入相邻肌肉且额外间隙为2厘米时神经瘤形成的发展情况（n = 12）。使用不同长度的间隙应能让人了解可能导致神经瘤形成的远端残端因素的稀释效应。九个月后，收集标本并进行组织学分析。测量神经瘤的横截面积并估计神经/结缔组织比率。
横截面积显示，短间隙组的神经瘤形成明显高于长间隙组，而肌肉覆盖组最小。神经组织百分比在肌肉覆盖组和长间隙组中最高，在短间隙组中最低。
这些结果表明神经瘤形成与远端残端距离之间存在关联。这一观察结果可能是由于当近端神经残端完全埋入肌肉时，源自远端残端的因素被阻断。对于临床应用，作者建议不仅将近端残端埋入肌肉中，还要通过手术增加近端和远端残端之间的间隙。
