Wolfe Scott W, Strauss Helene L, Garg Rohit, Feinberg Joseph
Hospital for Special Surgery, and Weill Medical College of Cornell University, New York, USA.
J Hand Surg Am. 2012 Oct;37(10):1980-5. doi: 10.1016/j.jhsa.2012.07.015.
The use of bioabsorbable conduits in digital nerve repair has demonstrated increased efficacy compared to direct repair (for gaps ≤ 4mm) and nerve grafting (for gaps ≥ 8 mm) for sensory recovery in a level 1 human trial. Although nonhuman primate studies on mixed motor-sensory nerves have documented comparable efficacy of the bioabsorbable nerve conduits when compared to nerve repair or grafting, there is minimal human clinical data on motor recovery following bioabsorbable nerve conduit repair. This study investigates the outcomes of bioabsorbable nerve conduits in pure motor nerve reconstruction for adult traumatic brachial plexus injuries.
Over a 3-year period, 21 adult patients had 1 or more nerve-to-nerve transfers for traumatic brachial plexus palsy performed using the operative microscope. Ten nerve transfers were performed by advancing the nerve ends into a semi-permeable type I collagen conduit stabilized with 8-0 nylon sutures (conduit-assisted neurorrhaphy). Twenty-eight concurrent nerve transfers were performed using standard end-to-end neurorrhaphy and 8-0 or 9-0 nylon sutures. Clinical evaluation using the Medical Research Council grading system (MRC) was performed at 1 and 2 years postoperatively. Postoperative electromyographic studies were performed in 28 of 38 transfers at final follow-up.
Thirty transfers (17 patients) were available for 2-year follow-up evaluation. All 10 transfers performed with nerve conduits demonstrated clinical recovery and electromyographic reinnervation at 2 years. Eighteen of 20 transfers performed without conduits demonstrated clinical recovery.
Although no statistical difference in functional recovery was seen in nerve transfers performed with collagen nerve conduits or by traditional neurorrhaphy, this pilot series demonstrated clinical and electromyographic recovery in 10 of 10 motor nerve repairs performed using conduits. These findings warrant continued investigation into the efficacy of conduit-assisted repair for motor nerves, especially in regards to operative time, precision of repair, and speed of nerve recovery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
在一项一级人体试验中，与直接修复（用于间隙≤4mm）和神经移植（用于间隙≥8mm）相比，在指神经修复中使用生物可吸收导管已显示出在感觉恢复方面更高的疗效。尽管对混合运动 - 感觉神经的非人灵长类动物研究表明，与神经修复或移植相比，生物可吸收神经导管具有相当的疗效，但关于生物可吸收神经导管修复后运动恢复的人类临床数据极少。本研究调查生物可吸收神经导管在成人创伤性臂丛神经损伤的纯运动神经重建中的结果。
在3年期间，21例成年患者因创伤性臂丛神经麻痹接受了1次或多次神经对神经转移手术，手术使用手术显微镜进行。10次神经转移是通过将神经末端推进到用8 - 0尼龙缝线固定的半透性I型胶原导管中进行的（导管辅助神经缝合术）。另外28次同时进行的神经转移使用标准端端神经缝合术和8 - 0或9 - 0尼龙缝线。术后1年和2年使用医学研究委员会分级系统（MRC）进行临床评估。在最终随访时，对38次转移中的28次进行了术后肌电图研究。
30次转移（17例患者）可进行2年随访评估。所有10次使用神经导管进行的转移在2年时均显示出临床恢复和肌电图再支配。20次未使用导管进行的转移中有18次显示出临床恢复。
尽管使用胶原神经导管进行的神经转移与传统神经缝合术在功能恢复方面没有统计学差异，但这个初步系列研究表明，在10次使用导管进行的运动神经修复中，有10次实现了临床和肌电图恢复。这些发现值得继续研究导管辅助修复运动神经的疗效，特别是在手术时间、修复精度和神经恢复速度方面。
研究类型/证据水平：治疗性IV级。
