Kim Jennifer S, Bonsu Nana-Yaw, Leland Hyuma A, Carey Joseph N, Patel Ketan M, Seruya Mitchel
From the Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Ann Plast Surg. 2018 May;80(5S Suppl 5):S311-S316. doi: 10.1097/SAP.0000000000001440.
Successful digital nerve repair is crucial in preventing painful neuroma formation and restoring sensory function after traumatic hand injury. The purpose of this study is to identify prognostic factors affecting sensory recovery following digital nerve reconstruction.
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines including studies reporting patients 18 years and older, greater than 10 reconstructed digital nerves, and greater than or equal to 3 months follow-up. Studies with proximal nerve injuries in the same distribution or inadequate sensory data were excluded. Included studies were evaluated by methodological index for nonrandomized studies score. Possible predictors were examined using the t test and 1-way analysis of variance with α ≤ 0.05.
Twenty-five studies met the inclusion criteria, consisting of 818 surgically reconstructed digital nerves (mean age, 38 years; 78% male) with a mean ± SD defect length of 1.5 ± 0.5 cm. Mean follow-up time was 22 months. Fifty-six percent of patients presented with concomitant injuries to tendons (31%) and the digital artery (13%). Mean ± SD time to surgical repair was 36 ± 73.8 days. Reconstructive techniques included 35% end-to-end primary neurorrhaphy, 31% nerve grafts, and 11% synthetic conduits. Postoperatively, 81% of the patients demonstrated sensory recovery of S3+/S4, with 45% complaining of hyperesthesia. Nerve reconstructions performed within 15 days of injury had significantly better static 2-point discrimination than delayed procedures (P = 0.02). Static 2-point discrimination measurements were also significantly better for shorter defect lengths (<1.3 cm, P = 0.05). No significant functional differences were found across age, follow-up time, injured digit or side, nor reconstructive technique.
Digital nerve reconstruction has good to excellent sensory recovery in up to 81% of patients with improved results in nerve gaps less than 1.3 cm. Performing the reconstruction within 15 days of injury is also correlated with improved sensory recovery.
成功的指神经修复对于预防创伤性手部损伤后疼痛性神经瘤形成和恢复感觉功能至关重要。本研究的目的是确定影响指神经重建后感觉恢复的预后因素。
根据系统评价和Meta分析的首选报告项目指南进行系统评价，纳入报告18岁及以上患者、超过10条重建指神经以及随访时间大于或等于3个月的研究。排除同一分布近端神经损伤或感觉数据不足的研究。纳入的研究采用非随机研究方法学指数评分进行评估。使用t检验和单因素方差分析对可能的预测因素进行检验，α≤0.05。
25项研究符合纳入标准，包括818条手术重建的指神经（平均年龄38岁；78%为男性），平均±标准差缺损长度为1.5±0.5 cm。平均随访时间为22个月。56%的患者伴有肌腱损伤（31%）和指动脉损伤（13%）。手术修复的平均±标准差时间为36±73.8天。重建技术包括35%的端端一期神经缝合、31%的神经移植和11%的合成导管。术后，81%的患者感觉恢复至S3+/S4，45%的患者抱怨感觉过敏。伤后15天内进行的神经重建比延迟手术的静态两点辨别力明显更好（P = 0.02）。对于较短的缺损长度（<1.3 cm，P = 0.05），静态两点辨别力测量也明显更好。在年龄、随访时间、受伤手指或侧别以及重建技术方面未发现显著的功能差异。
指神经重建在高达81%的患者中具有良好至极佳的感觉恢复，神经缺损小于1.3 cm时效果更佳。在伤后15天内进行重建也与感觉恢复改善相关。
