Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
J Neurosurg. 2013 Sep;119(3):733-8. doi: 10.3171/2013.4.JNS121938. Epub 2013 Jun 7.
The authors present the case of a 20-year-old man who, 3 months after his initial injury, underwent repair of a 1.7-cm defect of the ulnar nerve at the wrist; repair was performed with an acellular nerve allograft. Given the absence of clinical or electrophysiological recovery at 8 months postrepair, the patient underwent reexploration, excision of the "regenerated cable," and rerepair of the ulnar nerve with sural nerve autografts. Histology of the cable demonstrated minimal axonal regeneration at the midpoint of the repair. At the 6- and 12-month follow-ups of the sural nerve graft repair, clinical and electrophysiological evidence of both sensory and motor reinnervation of the ulnar nerve and associated hand muscles was demonstrated. In this report, the authors describe a single case of failed acellular nerve allograft and correlate the results with basic science and human studies reporting length and diameter limitations in human nerve repair utilizing grafts or conduits devoid of viable Schwann cells.
作者报告了一例 20 岁男性的病例，该患者在初次受伤后 3 个月，在腕部接受了 1.7 厘米的尺神经无细胞同种异体神经修复；修复采用的是去细胞神经同种异体移植物。由于修复后 8 个月时没有临床或电生理恢复，患者接受了再次探查，切除“再生电缆”，并用腓肠神经自体移植物修复尺神经。电缆的组织学显示修复中点处有极少量的轴突再生。在腓肠神经移植物修复后的 6 个月和 12 个月随访中，尺神经和相关手部肌肉均显示出感觉和运动神经再支配的临床和电生理证据。在本报告中，作者描述了一例失败的去细胞神经同种异体移植物，并将结果与基础科学和人体研究进行了关联，这些研究报告了在利用无活性施万细胞的移植物或导管修复人体神经时，长度和直径存在限制。
