Kuffler Damien P
Institute of Neurobiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico 00901, USA.
Int Rev Neurobiol. 2009;87:347-62. doi: 10.1016/S0074-7742(09)87018-9.
Clinically, little can be done to induce restoration of good to excellent neurological function following nervous system trauma, and time is required before an effective technique is developed and applied clinically. However, there are novel techniques that have not been tested experimentally or clinically that may induce significantly faster, reliable, and extensive neurological recovery following nervous system trauma than is presently possible, even for techniques currently being tested on animal models. To repair peripheral nerves following trauma in which a length of the nerve pathway is destroyed, many clinicians consider autologous sensory nerve grafts to be the "gold standard" for inducing neurological recovery. However, this technique has severe limitations, such as being effective only across gaps less than 2 cm, for repairs performed less than 2 months posttrauma, and in young patients. As a consequence, many patients suffer permanent neurological deficits or recover only limited neurological function, and they frequently develop irreversible neuropathic pain. This review examines the clinical role that immunosuppressants might play, in the presence or absence of autologous, allografts, or xenografts, in increasing the rate, success, and extent of neurological recovery following nervous system trauma.
临床上，在神经系统创伤后几乎无法促使恢复至良好或极佳的神经功能，且在开发出有效的技术并应用于临床之前需要时间。然而，存在一些尚未经过实验或临床测试的新技术，这些技术可能会在神经系统创伤后诱导出比目前更快、更可靠且更广泛的神经恢复，甚至对于目前正在动物模型上测试的技术也是如此。为了修复创伤后神经通路长度被破坏的周围神经，许多临床医生认为自体感觉神经移植是诱导神经恢复的“金标准”。然而，该技术存在严重局限性，例如仅在创伤后不到2个月、神经间隙小于2厘米以及年轻患者中进行修复时才有效。因此，许多患者会出现永久性神经功能缺损或仅恢复有限的神经功能，并且他们经常会发展为不可逆的神经性疼痛。本综述探讨了免疫抑制剂在有或没有自体移植、同种异体移植或异种移植的情况下，在提高神经系统创伤后神经恢复的速度、成功率和程度方面可能发挥的临床作用。
