Walton R L, Brown R E, Matory W E, Borah G L, Dolph J L
Division of Plastic Surgery, University of Massachusetts Medical Center, Worcester.
Plast Reconstr Surg. 1989 Dec;84(6):944-9; discussion 950-2.
Twenty-two digital nerve repairs were performed in the finger using autogenous vein grafts. Eighty-two percent of the repairs were available for follow-up. Results of sensibility return were assessed using moving two-point discrimination, Semmes-Weinstein monofilaments, and vibratory testing. Two-point discrimination averaged 4.6 mm for 11 acute digital nerve repairs using vein conduits 1 to 3 cm in length. Delayed digital nerve repair with vein conduits yielded poor results. Semmes-Weinstein values demonstrated comparable levels of return of slowly adapting fiber/receptors to the quickly adapting fiber/receptors, as evidenced by moving two-point discrimination tests. Vibratory sensibility was present in all. A review of previous experiences with end-to-end digital neurorrhaphies and digital nerve grafting suggests that repair of 1- to 3-cm gaps in digital nerves with segments of autologous vein grafts appears to give comparable results to nerve grafting. Further laboratory and clinical research is necessary to better define the role of interpositional vein conduits for repair of peripheral nerves.
在手指上使用自体静脉移植物进行了22例指神经修复。82%的修复可供随访。使用移动两点辨别法、Semmes-Weinstein单丝和振动测试来评估感觉恢复结果。对于11例使用长度为1至3厘米的静脉导管进行的急性指神经修复,两点辨别平均为4.6毫米。使用静脉导管进行延迟指神经修复效果不佳。Semmes-Weinstein值显示,慢适应纤维/感受器与快适应纤维/感受器的恢复水平相当,移动两点辨别测试证明了这一点。所有患者均存在振动感觉。回顾以往端端指神经缝合和指神经移植的经验表明,用自体静脉移植物段修复指神经1至3厘米的缺损,其效果似乎与神经移植相当。需要进一步的实验室和临床研究,以更好地确定间置静脉导管在周围神经修复中的作用。