Ochs G, Schenk M, Struppler A
Department of Neurology and Clinical Neurophysiology, Technische Universität Munich, F.R.G.
Brain Res. 1989 Sep 4;496(1-2):228-40. doi: 10.1016/0006-8993(89)91070-6.
Thirty-three patients with complete median, ulnar or digital nerve transections were studied 4 months to 13 years subsequent to suture or nerve grafting. In all cases, sensory disturbances, in terms of paraesthesia or hypaesthesia, were encountered. Painful or unpleasant symptoms, allodynia or hyperpathia, were observed most frequently in patients with poor recovery. The clinical findings and the patients' subjective complaints were correlated to microneurographic single fibre recordings of regenerated cutaneous mechanoreceptors. In more than 80% of the recordings, discharge properties of regenerated receptors, thresholds and a variety of other electrophysiological data were similar or equal to normal controls. Less than 20% of the receptors exhibited atypical properties suggesting defective steady-state regeneration. The ratio of rapidly adapting (RA-units) to slowly adapting mechanoreceptors (SA-units) was inverse in relation to normals. The density of regenerated RA-receptors was higher in the proximal than in the distal part of the reinnervated area. This paralleled the clinical finding of reduced sensory discrimination in these cases and suggests that SA-units may regenerate preferentially. In painful conditions no single fibres could be recorded, reflecting the relative paucity of fibres and probably the atrophy of the nerve. The results of the microstimulation experiments, although less reliable, revealed some evidence that the central processing of regenerated units is abnormal. Clinical and electrophysiological data supported this concept of central changes underlying some of the phenomena observed during peripheral nerve regeneration.
对33例正中神经、尺神经或指神经完全横断并在缝合或神经移植后4个月至13年的患者进行了研究。在所有病例中，均出现了感觉障碍，表现为感觉异常或感觉减退。疼痛或不适症状，如痛觉过敏或感觉异常，在恢复较差的患者中最为常见。临床发现和患者的主观主诉与再生皮肤机械感受器的微神经图单纤维记录相关。在超过80%的记录中，再生感受器的放电特性、阈值和各种其他电生理数据与正常对照组相似或相等。不到20%的感受器表现出非典型特性，提示稳态再生存在缺陷。快速适应（RA单位）与缓慢适应机械感受器（SA单位）的比例与正常情况相反。再生RA感受器的密度在再支配区域的近端高于远端。这与这些病例中感觉辨别力降低的临床发现相平行，提示SA单位可能优先再生。在疼痛情况下，无法记录到单纤维，这反映了纤维数量相对较少，可能还有神经萎缩。微刺激实验的结果虽然不太可靠，但显示出一些证据表明再生单位的中枢处理是异常的。临床和电生理数据支持了这种关于周围神经再生过程中观察到的一些现象背后中枢变化的概念。
