Pertici Vincent, Laurin Jérôme, Marqueste Tanguy, Decherchi Patrick
Aix-Marseille Université (AMU) and Centre National de la Recherche Scientifique (CNRS), UMR 7287 « Institut des Sciences du Mouvement (ISM) : Etienne-Jules MAREY », Equipe « Plasticité des Systèmes Nerveux et Musculaire », Parc Scientifique et Technologique de Luminy, Faculté des Sciences du Sport de Marseille, CC910 - 163 Avenue de Luminy, 13288, Marseille, Cedex 09, France.
Acta Neurochir (Wien). 2014 Aug;156(8):1577-90. doi: 10.1007/s00701-014-2117-6. Epub 2014 May 30.
To date, fibrin sealant is considered to be one of the most effective substitutes to prevent post-operative fibrosis and to limit neuroma formation after nerve suture. Because fibrin sealant presents a number of drawbacks, more suitable techniques should be considered. The aim of this study was to functionally and histologically compare the efficiency of a fibrin sealant to a resorbable semi-permeable porcine type I collagen membrane after a peroneal nerve lesion and repair on rats.
Rats were divided into four groups: (1) a SHAM group (n = 10) in which surgery was performed without damaging the nerve, (2) a LESION group (n = 15) in which the nerve was cut and immediately sutured without additional treatment, (3) a MEMBRANE group (n = 30) in which a collagen membrane was wrapped around the lesion site, and (4) a GLUE group (n = 30) in which the peroneal nerve was coated by fibrin sealant. Peroneal Functional Index (PFI), kinematic analysis of locomotion, muscular atrophy, axonal regrowth, and irritant ranking score (IRS) were performed during three months post-surgery.
Our results indicate that at the third month post-surgery, no difference in both the functional recovery and the histological measurement was observed between groups. However, no deleterious effect was observed following the use of the collagen membrane. Indeed, the porcine membrane was well-integrated into the host tissue, with no noticeable foreign body reaction at three months post-surgery.
Our preliminary results highlight the fact that the collagen membrane could be used as an alternative to fibrin sealant in peripheral nerve repair surgery. Indeed, animals in which the collagen membrane was used to wrap the lesion site exhibited similar functional and histological results as animals in which a fibrin sealant was used to coat the lesion. The greatest advantage of this membrane is that it could be used as a drug delivery device, regulated by its degradation rate.
迄今为止，纤维蛋白密封剂被认为是预防术后纤维化和限制神经缝合后神经瘤形成的最有效替代品之一。由于纤维蛋白密封剂存在许多缺点，应考虑更合适的技术。本研究的目的是在大鼠腓总神经损伤和修复后，从功能和组织学方面比较纤维蛋白密封剂与可吸收半透性猪I型胶原膜的效果。
将大鼠分为四组：（1）假手术组（n = 10），手术时不损伤神经；（2）损伤组（n = 15），切断神经并立即缝合，不进行额外处理；（3）膜组（n = 30），在损伤部位包裹胶原膜；（4）胶水组（n = 30），用纤维蛋白密封剂覆盖腓总神经。在术后三个月内进行腓总神经功能指数（PFI）、运动学分析、肌肉萎缩、轴突再生和刺激分级评分（IRS）。
我们的结果表明，术后第三个月，各组之间在功能恢复和组织学测量方面均未观察到差异。然而，使用胶原膜后未观察到有害影响。事实上，猪膜与宿主组织良好整合，术后三个月未观察到明显的异物反应。
我们的初步结果突出了这样一个事实，即胶原膜可作为外周神经修复手术中纤维蛋白密封剂的替代品。的确，用胶原膜包裹损伤部位的动物与用纤维蛋白密封剂覆盖损伤部位的动物表现出相似的功能和组织学结果。这种膜的最大优点是它可以作为一种药物递送装置，由其降解速率调节。
