一种促进人手指神经轴突融合的新疗法。
A novel therapy to promote axonal fusion in human digital nerves.
机构信息
From the Department of Plastic Surgery (R.B., R.N., D.C.R., R.B.B., K.W.S., R.B.S., W.P.T.), Vanderbilt University, Nashville, TN; Department of General Surgery (R.B.), Georgetown University, Washington, DC; Department of Orthopaedics (T.W., C.B., S.N.), Thammasat University, Pathumthani, Thailand; Georgetown University School of Medicine (D.C.R.), Washington, DC; Department of General Surgery (K.W.S.), University of Arkansas, Little Rock, AR; Vanderbilt University Institute of Imaging Science (N.D.K., M.D.D., R.D.D.), Nashville, TN; Department of Radiology and Radiological Sciences (R.D.D.), Vanderbilt University, Nashville, TN; and Department of Biomedical Engineering (R.D.D.), Vanderbilt University, Nashville, Tennessee.
出版信息
J Trauma Acute Care Surg. 2016 Nov;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S177-S183. doi: 10.1097/TA.0000000000001203.
BACKGROUND
Peripheral nerve injury can have a devastating impact on our military and veteran population. Current strategies for peripheral nerve repair include techniques such as nerve tubes, nerve grafts, tissue matrices, and nerve growth guides to enhance the number of regenerating axons. Even with such advanced techniques, it takes months to regain function. In animal models, polyethylene glycol (PEG) therapy has shown to improve both physiologic and behavioral outcomes after nerve transection by fusion of a portion of the proximal axons to the distal axon stumps. The objective of this study was to show the efficacy of PEG fusion in humans and to retrospectively compare PEG fusion to standard nerve repair.
METHODS
Patients with traumatic lacerations involving digital nerves were treated with PEG after standard microsurgical neurorrhaphy. Sensory assessment after injury was performed at 1 week, 2 weeks, 1 month, and 2 months using static two-point discrimination and Semmes-Weinstein monofilament testing. The Medical Research Council Classification (MRCC) for Sensory Recovery Scale was used to evaluate the level of injury. The PEG fusion group was compared to patient-matched controls whose data were retrospectively collected.
RESULTS
Four PEG fusions were performed on four nerve transections in two patients. Polyethylene glycol therapy improves functional outcomes and speed of nerve recovery in clinical setting assessed by average MRCC score in week 1 (2.8 vs 1.0, p = 0.03). At 4 weeks, MRCC remained superior in the PEG fusion group (3.8 vs 1.3, p = 0.01). At 8 weeks, there was improvement in both groups with the PEG fusion cohort remaining statistically better (4.0 vs 1.7, p = 0.01).
CONCLUSION
Polyethylene glycol fusion is a novel therapy for peripheral nerve repair with proven effectiveness in animal models. Clinical studies are still in early stages but have had encouraging results. Polyethylene glycol fusion is a potential revolutionary therapy in peripheral nerve repair but needs further investigation.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
背景
周围神经损伤会对我们的军人和退伍军人造成毁灭性的影响。目前，周围神经修复的策略包括神经管、神经移植、组织基质和神经生长引导等技术，以增加再生轴突的数量。即使采用如此先进的技术，也需要数月时间才能恢复功能。在动物模型中，聚乙二醇（PEG）治疗已被证明通过融合部分近端轴突到远端轴突残端，可改善神经横断后的生理和行为结果。本研究的目的是证明 PEG 融合在人类中的疗效，并回顾性比较 PEG 融合与标准神经修复。
方法
对伴有指神经撕裂伤的患者，在标准显微神经吻合术后行 PEG 治疗。采用静态两点辨别和 Semmes-Weinstein 单丝测试，分别在损伤后 1 周、2 周、1 个月和 2 个月进行感觉评估。采用感觉恢复的 Medical Research Council 分级（MRCC）评估损伤程度。将 PEG 融合组与回顾性收集的患者匹配对照进行比较。
结果
两名患者的 4 处神经横断处共进行了 4 次 PEG 融合。聚乙二醇治疗可改善周围神经修复的功能结果和神经恢复速度，在第 1 周平均 MRCC 评分方面表现更佳（2.8 分比 1.0 分，p = 0.03）。在第 4 周，PEG 融合组仍具有优势（3.8 分比 1.3 分，p = 0.01）。在第 8 周，两组均有改善，PEG 融合组仍具有统计学优势（4.0 分比 1.7 分，p = 0.01）。
结论
聚乙二醇融合是周围神经修复的一种新疗法，在动物模型中已证明有效。临床研究仍处于早期阶段，但已取得令人鼓舞的结果。聚乙二醇融合是周围神经修复的一种潜在的革命性疗法，但仍需进一步研究。
证据等级
治疗性研究，IV 级。
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