Rbia Nadia, Bulstra Liselotte F, Saffari Tiam M, Hovius Steven E R, Shin Alexander Y
Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Minnesota, USA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
World Neurosurg. 2019 Jul;127:e1176-e1184. doi: 10.1016/j.wneu.2019.04.087. Epub 2019 Apr 16.
A single-institution case series is reported and a review of the literature on the outcomes of digital nerve gap reconstruction with the NeuraGen type 1 collagen nerve conduit (Integra Life Sciences, Plainsboro New Jersey, USA) and the Avance Nerve Graft (Axogen Inc., Alachua, Florida, USA) is presented.
Thirty-seven patients were included with a minimal follow-up of 12 months. Primary outcome was postoperative sensory recovery measured by static 2-point discrimination test or the Semmes-Weinstein monofilament test. Secondary outcome measurements were perioperative or postoperative complications. Final outcome data were stratified to grade results as excellent, good, or poor.
The mean nerve gap length was 14 ± 4.9 mm for the collagen conduits versus 18.4 ± 9.3 for nerve allografts. After 12 months, outcomes were graded as excellent sensory recovery in 48% of the collagen conduit repairs and 39% of the nerve allografts (P = 0.608), good in 26% of the conduits and 55% of the allografts (P = 0.074), and poor in 26% of the conduits versus 6% of the allografts (P = 0.091). One neuroma and 1 infection were reported. Graft rejection or extrusion was not observed.
Nerve conduits and processed nerve allografts offer convenient off-the-shelf options for digital nerve gap repair. Both techniques offer effective means of reconstructing a digital nerve gap <2.5 cm at a minimum of 12 months of follow-up. Future prospective randomized large sample size studies comparing nerve conduits with allografts are needed to perform subgroup analyses and to define their exact role in digital nerve injuries.
报告一项单机构病例系列研究，并对使用NeuraGen 1型胶原神经导管（美国新泽西州普林斯顿的Integra Life Sciences公司）和Avance神经移植物（美国佛罗里达州阿拉楚阿的Axogen公司）进行指神经缺损重建的文献进行综述。
纳入37例患者，随访至少12个月。主要结局指标为术后感觉恢复情况，通过静态两点辨别试验或Semmes-Weinstein单丝试验进行测量。次要结局指标为围手术期或术后并发症。最终结局数据按优、良、差进行分层分级。
胶原导管组平均神经缺损长度为14±4.9mm，神经同种异体移植组为18.4±9.3mm。12个月后，48%的胶原导管修复和39%的神经同种异体移植感觉恢复评为优（P = 0.608），26%的导管修复和55%的同种异体移植评为良（P = 0.074），26%的导管修复和6%的同种异体移植评为差（P = 0.091）。报告了1例神经瘤和1例感染。未观察到移植物排斥或挤出。
神经导管和处理过的神经同种异体移植为指神经缺损修复提供了方便的现成选择。两种技术在至少12个月的随访中均为重建小于2.5cm的指神经缺损提供了有效的方法。未来需要进行比较神经导管与同种异体移植的前瞻性随机大样本研究，以进行亚组分析并确定它们在指神经损伤中的确切作用。
