Arda Mehmet S, Koçman Emre A, Özkara Emre, Söztutar Erdem, Özatik Orhan, Köse Aydan, Çetin Cengiz
Department of Pediatric Surgery, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey.
Department of Plastic Reconstructive and Esthetic Surgery, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey.
Balkan Med J. 2017 May 5;34(3):246-254. doi: 10.4274/balkanmedj.2015.1601. Epub 2017 Apr 6.
Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources and donor site morbidity are the major problems with peripheral nerve grafts. Although various types of autologous grafts such as arteries, veins and muscles have been recommended, an ideal conduit has not yet been described.
To investigate the effectiveness of a small intestinal conduit for peripheral nerve defects.
Animal experimentation.
Twenty-one rats were divided into three groups (n=7). Following anaesthesia, sciatic nerve exploration was performed in the Sham group. The 10 mm nerve gap was bridged with a 15 mm ileal segment in the small intestinal conduit group and the defect was replaced with orthotopic nerve in autologous nerve graft group. The functional recovery was tested monthly by walking-track analysis and the sciatic functional index. Histological evaluation was performed on the 12th week.
Sciatic functional index tests are better in autologous nerve graft group (-55.09±6.35); however, during follow-up, progress in sciatic functional index was demonstrated, along with axonal regeneration and innervation of target muscles in the small intestinal conduit group (-76.36±12.08) (p<0.05). In histologic sections, distinctive sciatic nerve regeneration was examined in the small intestinal conduit group. The expression of S-100 and neurofilament was observed in small intestinal conduit group but was less organised than in the autologous nerve graft group. Although the counted number (7459.79±1833.50 vs. 4226.51±1063.06 mm2), measured diameter [2.19 (2.15-2.88) vs. 1.74 (1.50-2.09) µm] and myelin sheath thickness [1.18 (1.09-1.44) vs. 0.66 (0.40-1.07) µm] of axons is significantly high in the middle sections of autologous nerve graft compared to the small intestinal conduit group, respectively (p<0.05), the peripheral nerve regeneration was also observed in the small intestinal conduit group.
Small intestinal conduit should not be considered as an alternative to autologous nerve grafts in its current form; however, the results are promising. Even though the results are no better than autologous nerve grafts, with additional procedures, it might be a good alternative due to harvesting abundant sources without donor site morbidity.
自体神经移植用于修复周围神经缺损。来源有限和供体部位并发症是周围神经移植的主要问题。尽管已经推荐了各种类型的自体移植物，如动脉、静脉和肌肉，但尚未描述出理想的导管。
研究小肠导管修复周围神经缺损的有效性。
动物实验。
将21只大鼠分为三组（n = 7）。麻醉后，假手术组进行坐骨神经探查。小肠导管组用15 mm回肠段桥接10 mm神经缺损，自体神经移植组用原位神经替代缺损。每月通过行走轨迹分析和坐骨神经功能指数测试功能恢复情况。在第12周进行组织学评估。
自体神经移植组的坐骨神经功能指数测试结果更好（-55.09±6.35）；然而，在随访期间，小肠导管组的坐骨神经功能指数有所改善，同时伴有轴突再生和靶肌肉的神经支配（-76.36±12.08）（p<0.05）。在组织学切片中，小肠导管组观察到明显的坐骨神经再生。小肠导管组观察到S-100和神经丝的表达，但不如自体神经移植组有序。尽管自体神经移植中间段的轴突计数数量（7459.79±1833.50对4226.51±1063.06 mm²）、测量直径[2.19（2.15 - 2.88）对1.74（1.50 - 2.09）µm]和髓鞘厚度[1.18（1.09 - 1.44）对0.66（0.40 - 1.07）µm]分别明显高于小肠导管组（p<0.05），但小肠导管组也观察到周围神经再生。
目前形式的小肠导管不应被视为自体神经移植的替代物；然而，结果是有希望的。尽管结果不比自体神经移植好，但通过额外的程序，由于其来源丰富且无供体部位并发症，它可能是一个很好的替代物。
