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使用己内酯神经管进行周围神经修复后的临床评估

Clinical Evaluation After Peripheral Nerve Repair With Caprolactone Neurotube.

作者信息

Costa Serrão de Araújo Gabriel, Couto Neto Bernardo, Harley Santos Botelho Renato, Carpi Malta Marcio

机构信息

Universidade Federal Fluminense, Niterói, Brazil; Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil.

Universidade Federal Fluminense, Niterói, Brazil; Universidade do Estado do Rio de Janeiro, Brazil.

出版信息

Hand (N Y). 2017 Mar;12(2):168-174. doi: 10.1177/1558944716643277. Epub 2016 Jul 8.

Abstract

Peripheral nerve injuries with substance loss are challenges to surgeons because direct suture repair may result in malfunction due to nerve suture tension. Autologous nerve grafts are alternatives for treating those lesions; however, harvesting grafts adds morbidity at donor sites. Synthetic substitutes are options to bridge the gaps in these situations. The caprolactone neurotubes are used to assist nerve regeneration, but the literature lacks studies that evaluate their results. This research was designed to clinically evaluate patients undergoing repair of peripheral nerves with that conduit. We described results of 12 case series consisting of operations with Neurolac®. All nerves severed were sensory and had small gaps (ie, less than 25 mm). Subjective and objective clinical evaluations were performed and registered. Physical examination by monofilament testing and 2-point discrimination showed results rated as good or excellent. However, the patients had complaints regarding sensory changes. Synthetic bioabsorbable guides for nerve repair are promising. The caprolactone conduits were demonstrated to be a safe option treatment and with a simple technique. Although in our study there were some operative complications, they were in line with previous descriptions in the literature. This case series added information about the treatment prognosis, but a higher evidence level study is necessary for decision making.

摘要

伴有实质缺损的周围神经损伤对外科医生来说是一项挑战,因为直接缝合修复可能因神经缝合张力而导致功能障碍。自体神经移植是治疗这些损伤的替代方法;然而,获取移植神经会增加供体部位的发病率。合成替代品是在这些情况下桥接神经缺损的选择。己内酯神经导管用于辅助神经再生,但文献中缺乏评估其效果的研究。本研究旨在对使用该导管修复周围神经的患者进行临床评估。我们描述了12例使用Neurolac®进行手术的病例系列结果。所有切断的神经均为感觉神经,且缺损较小(即小于25毫米)。进行了主观和客观的临床评估并记录。通过单丝测试和两点辨别法进行的体格检查显示结果评为良好或优秀。然而,患者有关于感觉变化的主诉。用于神经修复的合成生物可吸收引导物很有前景。己内酯导管被证明是一种安全的治疗选择,且技术简单。尽管在我们的研究中有一些手术并发症,但它们与文献中先前的描述一致。这个病例系列增加了关于治疗预后的信息,但需要更高证据水平的研究来进行决策。

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