Rinker Brian, Liau James Y
Division of Plastic Surgery, University of Kentucky, Lexington, KY 40536-0284, USA.
J Hand Surg Am. 2011 May;36(5):775-81. doi: 10.1016/j.jhsa.2011.01.030. Epub 2011 Apr 12.
The optimal management of a nerve gap within the fingers remains an unanswered question in hand surgery. The purpose of this study was to compare the sensory recovery, cost, and complication profile of digital nerve repair using autogenous vein and polyglycolic acid conduits.
We enrolled patients undergoing repair of digital nerve injuries with gaps precluding primary repair. The minimum gap that was found to preclude primary repair was 4 mm. Each nerve repair was randomized to the type of nerve repair with either a woven polyglycolic acid conduit or autogenous vein. Time required for repair was recorded. We performed sensory testing, consisting of static and moving 2-point discrimination, at 6 and 12 months after repair. We compared patient factors between the 2 groups using chi-square and Student's t-test. We compared sensory recovery between the 2 groups at each time point using Student's t-test and compared time and cost of repair.
We enrolled 42 patients with 76 nerve repairs. Of these, 37 patients (representing 68 repairs) underwent sensory evaluation at the 6-month time point. The median age in this group was 35 years. We repaired 36 nerves with synthetic conduit and 32 with vein. Nerve gaps ranged from 4 to 25 mm (mean, 10 mm). Study groups were not significantly different regarding age, time to repair, gap length, medical history, smoking history, or worker's compensation status. Time to harvest the vein was longer but the average cost of materials and surgery in the vein group was $1,220, compared with $1,269 for synthetic conduit repairs. These differences were not statistically significant. Mean static and moving 2-point discrimination at 6 months for the synthetic conduit group were 8.3 ± 2.0 and 6.6 ± 2.3, respectively, compared with 8.5 ± 1.8 and 7.1 ± 2.2 for the vein group. Values at 12 months for the synthetic conduit group were 7.5 ± 1.9 and 5.6 ± 2.2, compared with 7.6 ± 2.6 and 6.6 ± 2.9 for the vein group. These differences were not statistically significant. Smokers and worker's compensation patients had a worse sensory recovery at 12 months postrepair. There were 2 extrusions in the synthetic conduit group requiring reoperation; however, the difference in extrusion rate was not found to be statistically significant.
Sensory recovery after digital nerve reconstruction with autogenous vein conduit was equivalent to that using polyglycolic acid conduit, with a similar cost profile and fewer postoperative complications.
手指内神经缺损的最佳处理方法在手外科领域仍是一个未解决的问题。本研究的目的是比较使用自体静脉和聚乙醇酸导管进行指神经修复后的感觉恢复情况、成本及并发症情况。
我们纳入了因神经缺损无法进行一期修复而接受指神经损伤修复的患者。发现无法进行一期修复的最小缺损为4毫米。每次神经修复随机采用编织聚乙醇酸导管或自体静脉进行神经修复。记录修复所需时间。在修复后6个月和12个月进行感觉测试，包括静态和动态两点辨别觉测试。我们使用卡方检验和学生t检验比较两组患者的因素。使用学生t检验比较两组在每个时间点的感觉恢复情况，并比较修复时间和成本。
我们纳入了42例患者，共进行76次神经修复。其中，37例患者（代表68次修复）在6个月时间点接受了感觉评估。该组患者的中位年龄为35岁。我们用合成导管修复了36条神经，用静脉修复了32条神经。神经缺损范围为4至25毫米（平均10毫米）。研究组在年龄、修复时间、缺损长度、病史、吸烟史或工伤赔偿状况方面无显著差异。获取静脉的时间较长，但静脉组材料和手术的平均成本为1220美元，而合成导管修复为1269美元。这些差异无统计学意义。合成导管组在6个月时的平均静态和动态两点辨别觉分别为8.3±2.0和6.6±2.3，而静脉组为8.5±1.8和7.1±2.2。合成导管组在12个月时的值为7.5±1.9和5.6±2.2，静脉组为7.6±2.6和6.6±2.9。这些差异无统计学意义。吸烟者和工伤赔偿患者在修复后12个月时感觉恢复较差。合成导管组有2例发生挤压需要再次手术；然而，挤压率的差异无统计学意义。
自体静脉导管进行指神经重建后的感觉恢复与聚乙醇酸导管相当，成本相近且术后并发症更少。
