Siemionow Maria, Bobkiewicz Adam, Cwykiel Joanna, Uygur Safak, Francuzik Wojciech
From the *Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL; †Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH; ‡Department of General Surgery, Gastroenterological Oncology and Endocrine Surgery, Poznan University of Medical Sciences, Poznan, Poland; and §Department of Dermatology, Venerology and Allergology Charité-Universitätsmedizin Berlin, Berlin, Germany.
Ann Plast Surg. 2017 Oct;79(4):377-384. doi: 10.1097/SAP.0000000000001117.
Terminal neuromas resulting from severe nerve injuries and traumatic or surgical limb amputations can become a source of pain, and significantly impair patients' quality of life. Recently, the number of patients with peripheral nerve injuries increased due to modern war conflicts, natural disasters, and traffic accidents. This study investigated the efficacy of the epineural sheath jacket (ESJ) as a novel technique for neuroma prevention in the rat sciatic nerve model.
A 20-mm segment of the right sciatic nerve was excised in 18 Lewis rats, and the animals were divided into 3 experimental groups (n = 6/group): group I-control, nerve stump without protection; group II-muscle burying group, nerve stump buried in the muscle; group III-ESJ group, nerve stump protected by ESJ. The ESJ was created from the excised sciatic nerve and applied as a "cap" over the proximal nerve stump. The presence of neuropathic pain was assessed weekly by pinprick test and Tinel sign, up to 24 weeks postsurgery. At 24 weeks, assessments, such as macroscopic evaluation, retrograde neuronal labeling analysis, histomorphometry, and neural/connective tissue ratio were performed.
Epineural sheath jacket significantly reduced neuroma formation, which was associated with decreased Tinel sign (16.7%, P < 0.05) response compared with the nerve stump control. Moreover, ESJ reduced axonal sprouting, bulb-shaped nerve ending formation and perineural adhesions, as confirmed by macroscopic evaluation. Histological evaluation confirmed that nerve stumps protected with the ESJ showed less fibrosis and presented well-organized axonal structure. Neural/connective tissue ratio and retrograde neuronal labeling analysis revealed significantly improved results in the ESJ group compared to the control nerve stump group (P = 0.032 and P = 0.042, respectively).
The protective effect of the ESJ against neuroma formation was confirmed by behavioral and histological analyses, showing outcomes comparable to the muscle burying technique-the criterion standard of neuroma management.
严重神经损伤以及肢体创伤或手术截肢导致的终末神经瘤可成为疼痛来源，并显著损害患者生活质量。近年来，由于现代战争冲突、自然灾害和交通事故，周围神经损伤患者数量有所增加。本研究在大鼠坐骨神经模型中探究了神经外膜鞘套（ESJ）作为一种预防神经瘤的新技术的疗效。
在18只Lewis大鼠中切除右侧坐骨神经的一段20毫米节段，并将动物分为3个实验组（每组n = 6）：I组为对照组，神经残端未作保护；II组为肌肉埋植组，神经残端埋入肌肉；III组为ESJ组，神经残端用ESJ保护。ESJ由切除的坐骨神经制成，并作为“帽”覆盖在近端神经残端上。术后每周通过针刺试验和Tinel征评估神经病理性疼痛的存在，直至术后24周。在24周时，进行宏观评估、逆行神经元标记分析、组织形态计量学以及神经/结缔组织比率等评估。
神经外膜鞘套显著减少了神经瘤形成，与神经残端对照组相比，Tinel征反应降低（16.7%，P < 0.05）。此外，宏观评估证实，ESJ减少了轴突发芽、球状神经末梢形成和神经周粘连。组织学评估证实，用ESJ保护的神经残端纤维化较少，轴突结构组织良好。神经/结缔组织比率和逆行神经元标记分析显示，与对照神经残端组相比，ESJ组的结果有显著改善（分别为P = 0.032和P = 0.042）。
行为学和组织学分析证实了ESJ对神经瘤形成的保护作用，其结果与肌肉埋植技术（神经瘤处理的标准方法）相当。
