Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
J Neurosurg. 2014 Jul;121(1):210-8. doi: 10.3171/2014.2.JNS131667. Epub 2014 Apr 11.
OBJECT.: The object of this study was to highlight the challenge of insufficient donor graft material in peripheral nerve surgery, with a specific focus on sciatic nerve transection requiring autologous sural nerve graft.
The authors performed an anatomical analysis of cadaveric sciatic and sural nerve tissue. To complement this they also present 3 illustrative clinical cases of sciatic nerve injuries with segmental defects. In the anatomical study, the cross-sectional area (CSA), circumference, diameter, percentage of neural tissue, fat content of the sural nerves, as well as the number of fascicles, were measured from cadaveric samples. The percentage of neural tissue was defined as the CSA of fascicles lined by perineurium relative to the CSA of the sural nerve surrounded by epineurium.
Sural nerve samples were obtained from 8 cadaveric specimens. Mean values and standard deviations from sural nerve measurements were as follows: CSA 2.84 ± 0.91 mm(2), circumference 6.67 ± 1.60 mm, diameter 2.36 ± 0.43 mm, fat content 0.83 ± 0.91 mm(2), and number of fascicles 9.88 ± 3.68. The percentage of neural tissue seen on sural nerve cross-section was 33.17% ± 4.96%. One sciatic nerve was also evaluated. It had a CSA of 37.50 mm(2), with 56% of the CSA representing nerve material. The estimated length of sciatic nerve that could be repaired with a bilateral sural nerve harvest (85 cm) varied from as little as 2.5 cm to as much as 8 cm.
Multiple methods have been used in the past to repair sciatic nerve injury but most commonly, when a considerable gap is present, autologous nerve grafting is required, with sural nerve being the foremost source. As evidenced by the anatomical data reported in this study, a considerable degree of variability exists in the diameter of sural nerve harvests. Conversely, the percentage of neural tissue is relatively consistent across specimens. The authors recommend that the peripheral nerve surgeon take these points into consideration during nerve grafting as insufficient graft material may preclude successful recovery.
本研究旨在强调外周神经外科中供体移植物材料不足的挑战，特别是在需要自体腓肠神经移植物的坐骨神经切断术中。
作者对尸体坐骨神经和腓肠神经组织进行了解剖分析。为了补充这一点，他们还介绍了 3 例坐骨神经损伤伴节段性缺损的临床病例。在解剖研究中，从尸体样本中测量了腓肠神经的横截面积（CSA）、周长、直径、神经组织百分比、脂肪含量以及束数。神经组织百分比定义为被神经外膜包围的束 CSA 与被神经外膜包围的腓肠神经 CSA 之比。
从 8 具尸体标本中获得腓肠神经样本。腓肠神经测量的平均值和标准差如下：CSA 2.84±0.91mm²、周长 6.67±1.60mm、直径 2.36±0.43mm、脂肪含量 0.83±0.91mm²和束数 9.88±3.68。腓肠神经横断面上观察到的神经组织百分比为 33.17%±4.96%。还评估了 1 条坐骨神经。它的 CSA 为 37.50mm²，其中 56%的 CSA 代表神经材料。用双侧腓肠神经采集修复坐骨神经的估计长度（85cm）从 2.5cm 到 8cm 不等。
过去已经使用了多种方法来修复坐骨神经损伤，但最常见的是，当存在较大间隙时，需要自体神经移植，腓肠神经是最主要的来源。正如本研究报告的解剖数据所示，腓肠神经采集的直径存在很大的变异性。相反，神经组织的百分比在标本之间相对一致。作者建议外周神经外科医生在神经移植时考虑到这些要点，因为移植物材料不足可能会妨碍成功恢复。
