Orthopaedic Pathophysiology and Regenerative Medicine Unit, Istituto Ortopedico Rizzoli, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Neurosurgery. 2019 Nov 1;85(5):575-604. doi: 10.1093/neuros/nyy374.
Peripheral nerve reconstruction is a difficult problem to solve. Acellular nerve allografts (ANAs) have been widely tested and are a promising alternative to the autologous gold standard. However, current reconstructive methods still yield unpredictable and unsuccessful results. Consequently, numerous studies have been carried out studying alternatives to plain ANAs, but it is not clear if nerve regeneration potential exists between current biological, chemical, and physical enrichment modes.
To systematically review the effects of cell-enhanced ANAs on regeneration of peripheral nerve injuries.
PubMed, ScienceDirect, Medline, and Scopus databases were searched for related articles published from 2007 to 2017. Inclusion criteria of selected articles consisted of (1) articles written in English; (2) the topic being cell-enhanced ANAs in peripheral nerve regeneration; (3) an in vivo study design; and (4) postgrafting neuroregenerative assessment of results. Exclusion criteria included all articles that (1) discussed central nervous system ANAs; (2) consisted of xenografts as the main topic; and (3) consisted of case series, case reports or reviews.
Forty papers were selected, and categorization included the animal model; the enhancing cell types; the decellularization method; and the neuroregenerative test performed. The effects of using diverse cellular enhancements combined with ANAs are discussed and also compared with the other treatments such as autologous nerve graft, and plain ANAs.
ANAs cellular enhancement demonstrated positive effects on recovery of nerve function. Future research should include clinical translation, in order to increase the level of evidence available on peripheral nerve reconstruction.
周围神经重建是一个难以解决的问题。去细胞异体神经移植物（ANAs）已经被广泛测试，是自体金标准的有前途的替代品。然而，目前的重建方法仍然产生不可预测和不成功的结果。因此，已经进行了许多研究来研究替代普通的 ANAs，但目前的生物、化学和物理富集模式之间是否存在神经再生潜力还不清楚。
系统评价细胞增强型 ANAs 对周围神经损伤再生的影响。
检索 2007 年至 2017 年发表的相关文献，包括 PubMed、ScienceDirect、Medline 和 Scopus 数据库。纳入标准为：（1）用英文书写的文章；（2）主题为细胞增强型 ANAs 在周围神经再生中的应用；（3）采用体内研究设计；（4）对移植后神经再生结果进行神经再生评估。排除标准包括：（1）讨论中枢神经系统 ANAs 的文章；（2）以异种移植物为主要内容的文章；（3）病例系列、病例报告或综述。
选择了 40 篇论文，分类包括动物模型、增强细胞类型、去细胞化方法和进行的神经再生测试。讨论了使用不同细胞增强物与 ANAs 联合应用的效果，并与自体神经移植物和普通 ANAs 等其他治疗方法进行了比较。
ANAs 细胞增强对神经功能的恢复有积极作用。未来的研究应包括临床转化，以提高周围神经重建的证据水平。
