Isaacs Jonathan, Safa Bauback
Virginia Commonwealth University, Richmond, VA, USA.
The Buncke Clinic, San Francisco, CA, USA.
Hand (N Y). 2017 Jan;12(1):55-59. doi: 10.1177/1558944716646782. Epub 2016 May 3.
Cabled sensory nerve autografts are the historical gold standard for overcoming gaps in larger diameter nerves as repair utilizing large-diameter autograft risks central graft necrosis. Commercially available processed nerve allograft (PNA) is available in diameters up to 5 mm but represents an acellular 3-dimensional matrix as opposed to viable tissue. The purpose of this study is to specifically evaluate whether similar concerns regarding the use of large-caliber PNA are warranted. The RANGER Registry is an active database designed to collect injury, repair, safety, and outcomes data for PNAs (Avance® Nerve Graft; AxoGen, Inc, Alachua, Florida) according to an institutional review board-approved protocol. The database was queried for patients presenting with large-caliber nerve allograft repairs in the upper extremity. Identified patients reporting quantitative outcomes with a minimum of 9-month follow-up were included in the data set. The large-caliber PNA subgroup included 13 patients with 15 injuries. The mean ± SD age was 36 ± 22 years. Large-caliber single-stranded repairs included twelve 4- to 5-mm-diameter grafts. Large-caliber cabled repairs included the combined use of 3- to 4-mm and 4- to 5-mm-diameter nerve allografts in 3 repairs. The mean nerve gap was 33 ± 10 mm with a mean follow-up time of 13 months. Available quantitative data reported meaningful recovery of sensory and motor function in 67% and 85% of the repairs, respectively. Although based on a small subset of patients, PNAs of up to 5 mm in diameter appear capable of supporting successful nerve regeneration.
带缆线的感觉神经自体移植是克服大直径神经缺损的历史金标准，因为使用大直径自体移植进行修复有中央移植物坏死的风险。市售的处理过的神经同种异体移植物（PNA）直径可达5毫米，但它是一种无细胞的三维基质，而非有活力的组织。本研究的目的是专门评估对于使用大口径PNA是否也有类似的担忧。RANGER注册库是一个活跃的数据库，旨在根据机构审查委员会批准的方案收集PNA（Avance®神经移植物；AxoGen公司，佛罗里达州阿拉楚阿）的损伤、修复、安全性和结果数据。查询该数据库以获取上肢进行大口径神经同种异体移植修复的患者信息。确定报告了至少9个月随访定量结果的患者纳入数据集。大口径PNA亚组包括13例患者的15处损伤。平均年龄±标准差为36±22岁。大口径单股修复包括12根直径4至5毫米的移植物。大口径带缆线修复包括在3例修复中联合使用直径3至4毫米和4至5毫米的神经同种异体移植物。平均神经缺损为33±10毫米，平均随访时间为13个月。现有的定量数据显示，分别有67%和85%的修复实现了感觉和运动功能的有意义恢复。尽管基于一小部分患者，但直径达5毫米的PNA似乎能够支持成功的神经再生。
