Departments of1Plastic and Reconstructive Surgery and.
3Department of Brain Sciences, Imperial College London; and.
J Neurosurg. 2020 May 29;134(5):1590-1598. doi: 10.3171/2020.3.JNS191429. Print 2021 May 1.
Proximal peripheral nerve injuries often result in poor functional outcomes, chiefly because of the long time period between injury and the reinnervation of distal targets, which leads to muscle and Schwann cell atrophy. The supercharged end-to-side (SETS) nerve transfer is a recent technical innovation that introduces donor axons distally into the side of an injured nerve to rapidly innervate and support end organs while allowing for additional reinnervation after a proximal repair at the injury site. However, the mechanisms by which donor axons grow within the recipient nerve, contribute to muscle function, and impact the regeneration of native recipient axons are poorly understood. This uncertainty has slowed the transfer's clinical adoption. The primary objective of this article is to comprehensively review the mechanisms underpinning axonal regeneration and functional recovery after a SETS nerve transfer. A secondary objective is to report current clinical applications in the upper limb and their functional outcomes. The authors also propose directions for future research with the aim of maximizing the clinical utility of the SETS transfer for peripheral nerve surgeons and their patients.
周围神经近端损伤常导致不良的功能预后，主要是因为损伤与远端靶器官再神经支配之间的时间间隔较长，导致肌肉和许旺细胞萎缩。增强型端侧（SETS）神经转移是一种新技术创新，它将供体轴突远端引入损伤神经的侧支，以快速支配和支持终末器官，同时允许在损伤部位进行近端修复后进行额外的再神经支配。然而，供体轴突在受体神经内生长、促进肌肉功能以及影响内源性受体轴突再生的机制尚不清楚。这种不确定性减缓了该技术的临床应用。本文的主要目的是全面回顾 SETS 神经转移后轴突再生和功能恢复的机制。次要目的是报告上肢的当前临床应用及其功能结果。作者还提出了未来研究的方向，旨在最大限度地提高 SETS 转移对周围神经外科医生及其患者的临床应用价值。
