Yan Hede, Zhang Feng, Wang Chunyang, Xia Zhen, Mo Xiumei, Fan Cunyi
From the *Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital; †Department of Orthopaedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; ‡Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS; and §State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China.
Ann Plast Surg. 2015 Apr;74(4):454-61. doi: 10.1097/SAP.0000000000000266.
Capping techniques have been used as a treatment modality for the prevention of neuroma formation and the management of neuropathic pain. However, the results are inconsistent and unpredictable. We hypothesize that this situation may be attributable, in part, to the disparities in the type of materials used to manufacturing of the conduits.
In this study, a rat model was used and the sciatic nerve was selected for evaluation. In 1 capping group, a sciatic nerve stump was capped with a nonaligned nanofiber conduit (the nonaligned group), whereas in a second capping group, the conduit was made of aligned nanofibers (the aligned group). In another group, the sciatic nerve stump was not capped as a control (the control group). The results of autotomy behavior, extent of neuroma formation, histological changes in the neuroma, and the expression of c-fos as a pain marker in the fourth lumbar spinal cord were evaluated at 8 weeks postoperatively.
The control group presented more neuroma-like features in all the observed parameters in comparison with the 2 capping groups; of the 2 capping groups, the aligned group achieved even better outcomes than the nonaligned group.
Our findings indicate that the aligned nanofiber conduit is a promising biomaterial for the nerve capping technique, and new treatment strategies using aligned nanofiber conduits may be developed for the management of painful amputated neuromas.
封端技术已被用作一种治疗方式，用于预防神经瘤形成和处理神经性疼痛。然而，结果并不一致且不可预测。我们推测这种情况可能部分归因于用于制造导管的材料类型存在差异。
在本研究中，使用大鼠模型并选择坐骨神经进行评估。在一个封端组中，用未对齐的纳米纤维导管覆盖坐骨神经残端（未对齐组），而在另一个封端组中，导管由对齐的纳米纤维制成（对齐组）。在另一组中，坐骨神经残端不进行覆盖作为对照（对照组）。在术后8周评估自残行为结果、神经瘤形成程度、神经瘤的组织学变化以及作为疼痛标志物的c-fos在第四腰椎脊髓中的表达。
与两个封端组相比，对照组在所有观察参数中呈现出更多神经瘤样特征；在两个封端组中，对齐组的结果比未对齐组更好。
我们的研究结果表明，对齐的纳米纤维导管是用于神经封端技术的一种有前景的生物材料，并且可以开发使用对齐的纳米纤维导管的新治疗策略来处理疼痛性截肢神经瘤。
