Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
Sci Rep. 2018 Jan 12;8(1):620. doi: 10.1038/s41598-017-19134-8.
The repair of injured peripheral nerve is still challenging for surgeons. The end-to-end and tension-free neurorrhaphy is the current gold standard for reconstruction after complete nerve transection without significant defect. The main objective of this study neurorrhaphy in digit replantation affects the sensory recovery and neuropathic pain in replanted digit. Total 101 patients who received replantation of single completely amputated digit were included for analysis in this study. In group I (n = 49), the digital nerves were repaired with end-to-end and tension-free neurorrhaphy and then wrapped into a tendon-derived collagen nerve conduit. In group II (n = 52), the digital nerves were repaired with end-to-end and tension-free neurorrhaphy only. The static two-point discrimination (s2PD) was performed to evaluate sensory recovery. Visual analog scale (VAS) scores of pain at rest and with exertion were measured respectively. The s2PD tests at three and six months after surgery did not show any significant difference between the two groups. The VAS scores at rest and with exertion of group I were significantly reduced compared with those of group II at three and six months after surgery. Thus, we concluded that nerve wrap into a collagen conduit after end-to-end and tension-free neurorrhaphy could attenuate neuropathic pain after digit replantation but have no benefit for sensory recovery.
修复受损的周围神经仍然是外科医生面临的挑战。端端无张力神经吻合术是目前完全横断神经且无明显缺损时重建的金标准。本研究的主要目的是探讨断指再植中神经吻合方式对再植指感觉恢复和神经病理性疼痛的影响。本研究共纳入 101 例单指完全离断患者进行分析。在 I 组（n=49）中，将指神经行端端无张力神经吻合，并包裹于肌腱衍生的胶原神经导管中。在 II 组（n=52）中，仅行端端无张力神经吻合。采用静态两点辨别觉（s2PD）评估感觉恢复。分别测量静息和用力时的视觉模拟评分（VAS）。术后 3 个月和 6 个月的 s2PD 测试两组间无显著差异。与 II 组相比，I 组术后 3 个月和 6 个月静息和用力时的 VAS 评分均显著降低。因此，我们得出结论，端端无张力神经吻合后将神经包裹于胶原导管中可减轻断指再植后神经病理性疼痛，但对感觉恢复无益处。
