Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA.
J Reconstr Microsurg. 2011 Feb;27(2):83-90. doi: 10.1055/s-0030-1267834. Epub 2010 Oct 13.
Despite their inferiority to nerve autograft, clinical alternatives are commonly used for reconstruction of peripheral nerve injuries because of their convenient off-the-shelf availability. Previously, our group compared isografts with NeuraGen(®) (Integra, Plainsboro, NJ) nerve guides, which are a commercially available type I collagen conduit and processed rat allografts comparable to Avance(®) (AxoGen, Alachua, FL) human decellularized allograft product. From this study, qualitative observations were made of distinct differences in the pattern of regenerating fibers within conduits, acellular allografts, and isografts. In the current post hoc analysis, these observations were quantified. Using nerve density, we statistically compared the differential pattern of regenerating axon fibers within grafts and conduit. The conduits exhibited a consistent decrease in midgraft density when compared with the isograft and acellularized allografts at two gap lengths (14 mm and 28 mm) and time points (12 and 22 weeks). The decrease in density was accompanied by clustered distribution of nerve fibers in conduits, which contrasted the evenly distributed regeneration seen in processed allografts and isografts. We hypothesize that the lack of endoneurial microstructure of conduits results in the clustering regenerating fibers, and that the presence of microstructure in the acellularized allograft and isografts facilitates even distribution of regenerating fibers.
尽管它们不如神经自体移植物，但由于其方便的现成可用性，临床替代品通常被用于周围神经损伤的重建。此前，我们的小组比较了同种异体移植物与 NeuraGen(®)（Integra，Plainsboro，NJ）神经引导器，后者是一种市售的 I 型胶原导管和经过处理的大鼠同种异体移植物，与 Avance(®)（AxoGen，Alachua，FL）人脱细胞同种异体产品相当。从这项研究中，可以观察到导管、脱细胞同种异体移植物和同种异体移植物内再生纤维模式的明显差异。在当前的事后分析中，对这些观察结果进行了量化。使用神经密度，我们从统计学上比较了移植物和导管内再生轴突纤维的不同模式。与同种异体移植物和脱细胞化同种异体移植物相比，导管在两个间隙长度（14mm 和 28mm）和时间点（12 周和 22 周）时，中移植物密度持续下降。密度下降伴随着导管中神经纤维的聚集分布，与处理过的同种异体移植物和同种异体移植物中均匀分布的再生形成对比。我们假设导管缺乏内膜微观结构导致再生纤维聚集，而脱细胞化同种异体移植物和同种异体移植物中存在微观结构有利于再生纤维的均匀分布。
