Marcoccio Ignazio, Vigasio Adolfo
Hand Surgery and Orthopaedic Microsurgery Center, Istituto Clinico Città di Brescia–Gruppo San Donato, Brescia, Italy.
J Hand Surg Am. 2010 Sep;35(9):1418-26. doi: 10.1016/j.jhsa.2010.05.019.
Although vein conduits filled with fresh skeletal muscle have been used to bridge nerve defects both experimentally and clinically with good results, this approach has never been considered a valuable tool for reconstruction of nerve defects, and the technique has been abandoned. The purpose of this study was to evaluate the application of muscle-in-vein conduits for secondary digital nerves reconstruction, with particular emphasis on the surgical technique and results.
We present a retrospectively selected consecutive series of 21 digital nerve defects in 17 patients who were treated with vein conduits filled with fresh skeletal muscle for secondary nerve reconstruction. After a minimum follow-up of 18 months, all patients were studied with static and moving 2-point discrimination, Semmes-Weinstein monofilament testing, Visual Analog Scale, and Disabilities of the Arm, Shoulder, and Hand questionnaire. Outcome data were stratified according to the American Society for Surgery of the Hand guidelines, the modified Highet and Sander's criteria, and the Logic Tree.
The average nerve gap bridged with the muscle-in-vein conduit was 2.2 cm (range, 1-3.5 cm). We classified 14 of 22 reconstructed nerves as excellent or good according to American Society for Surgery of the Hand guidelines, whereas 17 were between S4 and S3 using modified Highet and Sander's criteria. The Logic Tree yielded results between S4 and S3 in 14 of 21 reconstructed nerves. The average Disabilities of the Arm, Shoulder, and Hand survey scores were 22.5 for the disability/symptoms module and 21.4 and 17 for the sports/music and work subcomponents, respectively.
Use of muscle-in-vein conduits should be considered and promoted for sensory nerve reconstruction for a number of reasons: the encouraging results with the technique; the abundant availability of both donor tissues; the flexibility of the conduit resulting from the combination of muscle and vein; the simplicity with which tubes can be fashioned; immunological compatibility; and the absence of adjunctive costs.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
尽管填充新鲜骨骼肌的静脉导管已被用于实验和临床中桥接神经缺损，且效果良好，但这种方法从未被视为重建神经缺损的有效工具，该技术也已被摒弃。本研究的目的是评估肌肉-静脉导管在二期指神经重建中的应用，尤其着重于手术技术和结果。
我们回顾性选取了17例患者的21例指神经缺损病例，这些患者接受了填充新鲜骨骼肌的静脉导管进行二期神经重建治疗。在至少随访18个月后，对所有患者进行了静态和动态两点辨别觉、Semmes-Weinstein单丝测试、视觉模拟评分以及手臂、肩部和手部功能障碍问卷评估。根据美国手外科协会指南、改良的Highet和Sander标准以及逻辑树对结果数据进行分层。
肌肉-静脉导管桥接的平均神经缺损为2.2厘米（范围为1至3.5厘米）。根据美国手外科协会指南，22条重建神经中有14条被归类为优或良；而根据改良的Highet和Sander标准，17条神经在S4和S3之间。逻辑树显示，21条重建神经中有14条的结果在S4和S3之间。手臂、肩部和手部功能障碍调查问卷的平均得分中，残疾/症状模块为22.5分，运动/音乐和工作子组件分别为21.4分和17分。
由于以下多个原因，应考虑并推广使用肌肉-静脉导管进行感觉神经重建：该技术取得了令人鼓舞的结果；供体组织丰富易得；肌肉和静脉结合使导管具有灵活性；制作导管简单；免疫相容性好；且无需额外费用。
研究类型/证据水平：治疗性IV级。
