Pulley Benjamin Richard, Luo Tianyi David, Barnwell Jonathan C, Smith Beth P, Smith Thomas L, Li Zhongyu
Department of Orthopaedic Surgery, Mount Carmel Health System, Columbus, OH, USA.
Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
Hand Microsurg. 2016;5(3):124-129. doi: 10.5455/handmicrosurg.215015.
Autologous nerve grafting remains the gold standard for repair of peripheral nerve injuries. Its use, however, is limited by donor nerve availability and donor site morbidity. This is especially problematic after failure of an initial autograft that requires a repeat nerve graft, resulting in a second surgical site with associated morbidity. Based on the molecular differences in nerve degeneration in the proximal and distal segments after transection, we hypothesized that a chronically-denervated proximal stump may be viable for autologous nerve repair.
20 Sprague-Dawley rats underwent right sciatic nerve excision and sural nerve transection. After 8 weeks, nerve repair was performed by harvesting the proximal segment of the sural nerve (n=10) or a fresh sural nerve (n=10) from the contralateral hind limb. Electrophysiological changes were analyzed to compare the fresh and denervated grafts.
Electrophysiological testing demonstrated higher compound motor action potential in the denervated group compared to the fresh autograft group, however this difference was not statistically significant (p=0.117).
The proximal segment of a chronically-denervated sural nerve can be as effective as a fresh sural nerve for autologous repair of peripheral nerve injuries in a rodent model.
自体神经移植仍是修复周围神经损伤的金标准。然而，其应用受到供体神经可用性和供体部位并发症的限制。在初次自体移植失败后需要再次进行神经移植时，这一问题尤为突出，会导致第二个手术部位出现相关并发症。基于神经横断后近端和远端节段神经变性的分子差异，我们推测长期去神经支配的近端残端可能适用于自体神经修复。
对20只Sprague-Dawley大鼠进行右侧坐骨神经切除和腓肠神经横断。8周后，通过取自同侧后肢的腓肠神经近端节段（n = 10）或新鲜腓肠神经（n = 10）进行神经修复。分析电生理变化以比较新鲜移植组和去神经支配移植组。
电生理测试显示，去神经支配组的复合运动动作电位高于新鲜自体移植组，但这种差异无统计学意义（p = 0.117）。
在啮齿动物模型中，长期去神经支配的腓肠神经近端节段在自体修复周围神经损伤方面与新鲜腓肠神经同样有效。
