Dornseifer U, Matiasek K, Fichter M A, Rupp A, Henke J, Weidner N, Kovacs L, Schmahl W, Biemer E, Ninkovic M, Papadopulos N A
Department of Plastic, Reconstructive, and Hand Surgery, Burn Center, Klinikum Bogenhausen - Städtisches Klinikum München GmbH, Munich, Germany.
Zentralbl Neurochir. 2007 Aug;68(3):101-10. doi: 10.1055/s-2007-984453. Epub 2007 Jul 30.
The severe functional deficits in patients suffering from traumatic peripheral nerve damage underline the necessity of an optimal therapy. The development of microsurgical techniques in the sixties contributed significantly to the progress in nerve repair. Since then, no major clinical innovation has become established. However, with an increased understanding of cellular and molecular mechanisms underlying nerve regeneration, various tubulization concepts have been developed which yield possible alternatives to direct suturing and to autologous nerve grafting in cases of short nerve defects. The vast knowledge gathered in the field of nerve regeneration needs to be further exploited in order to develop alternative therapeutic strategies to nerve autografting, which can result in donor-site defects and often lead to inappropriate results. Considering the encouraging results from preclinical studies, innovative nerve repair strategies are likely to improve the outcome of reconstructive surgical interventions. This paper outlines, in addition to the fundamentals of nerve regeneration, the current treatment options for defects of peripheral nerves. This article also reviews the developments in the use of alternative nerve guides and demonstrates new perspectives in the field of peripheral nerve reconstruction.
遭受创伤性周围神经损伤的患者存在严重的功能缺陷，这凸显了最佳治疗的必要性。20世纪60年代显微外科技术的发展对神经修复的进展做出了重大贡献。从那时起，尚未确立重大的临床创新。然而，随着对神经再生潜在细胞和分子机制的认识不断增加，已开发出各种管状化概念，在短神经缺损的情况下，这些概念为直接缝合和自体神经移植提供了可能的替代方案。为了开发替代神经自体移植的治疗策略，需要进一步利用神经再生领域积累的大量知识，神经自体移植可能会导致供体部位缺损，且常常导致不理想的结果。鉴于临床前研究的令人鼓舞的结果，创新的神经修复策略可能会改善重建手术干预的结果。除了神经再生的基本原理外，本文还概述了周围神经缺损的当前治疗选择。本文还回顾了替代神经导管使用方面的进展，并展示了周围神经重建领域的新前景。
