Rummings Wayne A, Honeycutt P Barrett, Jernigan Edward W, Weinhold Paul S, Draeger Reid W
Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States.
J Hand Microsurg. 2019 Apr;11(1):28-34. doi: 10.1055/s-0038-1654751. Epub 2018 Sep 27.
Peripheral neuroma formation results from partial or complete nerve division. Elucidating measures to prevent the development of peripheral neuromas is of clinical importance. The aim of this study was to determine the effect of various surgical nerve-cutting techniques on nerve microstructure and resultant neuroma formation. Twenty Sprague-Dawley rats were randomly assigned to one of the following nerve-cutting techniques: No. 15 scalpel blade with tongue depressor, micro-serrated scissors, nerve-cutting guide forceps with straight razor, and bipolar cauterization. The right sciatic nerve was transected using the assigned nerve-cutting technique. Neuromas were harvested 6 weeks postoperatively, and samples were obtained for histologic analysis. The contralateral sciatic nerve was transected at euthanasia and analyzed with histology and with scanning electron microscopy in a subset of the rats. Fifteen of the 20 rats survived the 6-week experiment. Scanning electron microscopy of the No. 15 scalpel blade group showed the most visual damage and disorganization whereas the nerve-cutting guide forceps and micro-serrated scissors groups resulted in a smooth transected surface. Bipolar cauterization appeared to enclose the fascicular architecture within a sealed epineurium. Each neuroma was significantly larger than contralateral controls. There were no significant differences in neuroma caliber between nerve transection groups. No substantial differences in microstructure were evident between transection groups. Despite disparate microscopic appearances of the cut surfaces of nerves using various nerve-cutting techniques, we found no significant differences in the caliber or incidence of neuroma formation based on nerve-cutting technique. Nerve-cutting technique used when transecting peripheral nerves may have little bearing on the formation or size of resultant neuroma formation.
周围神经瘤的形成是由部分或完全神经切断引起的。阐明预防周围神经瘤发展的措施具有临床重要性。本研究的目的是确定各种手术神经切断技术对神经微观结构和由此产生的神经瘤形成的影响。将20只Sprague-Dawley大鼠随机分配到以下神经切断技术之一：用压舌板的15号手术刀刀片、微锯齿剪刀、带直剃刀的神经切断导向钳和双极电凝。使用指定的神经切断技术横断右侧坐骨神经。术后6周收获神经瘤，并获取样本进行组织学分析。在安乐死时横断对侧坐骨神经，并在一部分大鼠中进行组织学和扫描电子显微镜分析。20只大鼠中有15只在6周的实验中存活下来。15号手术刀刀片组的扫描电子显微镜显示损伤和结构紊乱最为明显，而神经切断导向钳和微锯齿剪刀组导致横断表面光滑。双极电凝似乎将束状结构封闭在密封的神经外膜内。每个神经瘤明显大于对侧对照。神经切断组之间神经瘤直径没有显著差异。各横断组之间在微观结构上没有明显差异。尽管使用各种神经切断技术对神经断面进行显微镜观察的外观不同，但我们发现基于神经切断技术的神经瘤形成的直径或发生率没有显著差异。切断周围神经时使用的神经切断技术可能对由此产生的神经瘤形成的大小或形成几乎没有影响。
