Department of Orthopedic Surgery, University of Colorado, Aurora, CO; Department of Orthopaedic Surgery, Duke University, Durham, NC.
Arizona Center for Hand Surgery, Phoenix, AZ.
J Hand Surg Am. 2020 Dec;45(12):1148-1156. doi: 10.1016/j.jhsa.2020.07.016. Epub 2020 Oct 1.
Biomaterials used to restore digital nerve continuity after injury associated with a defect may influence ultimate outcomes. An evaluation of matched cohorts undergoing digital nerve gap reconstruction was conducted to compare processed nerve allograft (PNA) and conduits. Based on scientific evidence and historical controls, we hypothesized that outcomes of PNA would be better than for conduit reconstruction.
We identified matched cohorts based on patient characteristics, medical history, mechanism of injury, and time to repair for digital nerve injuries with gaps up to 25 mm. Data were stratified into 2 gap length groups: short gaps of 14 mm or less and long gaps of 15 to 25 mm. Meaningful sensory recovery was defined as a Medical Research Council scale of S3 or greater. Comparisons of meaningful recovery were made by repair method between and across the gap length groups.
Eight institutions contributed matched data sets for 110 subjects with 162 injuries. Outcomes data were available in 113 PNA and 49 conduit repairs. Meaningful recovery was reported in 61% of the conduit group, compared with 88% in the PNA group. In the group with a 14-mm or less gap, conduit and PNA outcomes were 67% and 92% meaningful recovery, respectively. In the 15- to 25-mm gap length group, conduit and PNA outcomes were 45% and 85% meaningful recovery, respectively. There were no reported adverse events in either treatment group.
Outcomes of digital nerve reconstruction in this study using PNA were consistent and significantly better than those of conduits across all groups. As gap lengths increased, the proportion of patients in the conduit group with meaningful recovery decreased. This study supports the use of PNA for nerve gap reconstruction in digital nerve reconstructions up to 25 mm.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
用于修复与缺陷相关的损伤后连续性中断的生物材料可能会影响最终结果。对接受指神经间隙重建的匹配队列进行了评估，以比较处理过的同种异体神经移植物（PNA）和导管。基于科学证据和历史对照，我们假设 PNA 的结果将优于导管重建。
我们根据患者特征、病史、损伤机制和修复时间，确定了最长达 25mm 的指神经间隙损伤的匹配队列。数据分为 2 个间隙长度组：短间隙（14mm 或更短）和长间隙（15 至 25mm）。有意义的感觉恢复定义为 Medical Research Council 量表 S3 或更高。通过在间隙长度组内和组间的修复方法比较有意义的恢复。
8 家机构为 110 名患者的 162 处损伤提供了匹配数据集。113 例 PNA 和 49 例导管修复的结果数据可用。导管组的有意义恢复率为 61%，而 PNA 组为 88%。在 14mm 或更短的间隙组中，导管和 PNA 的结果分别为 67%和 92%的有意义恢复。在 15 至 25mm 的间隙长度组中，导管和 PNA 的结果分别为 45%和 85%的有意义恢复。两组均无治疗相关不良事件报告。
本研究中使用 PNA 的指神经重建结果在所有组中均一致且显著优于导管。随着间隙长度的增加，导管组中有意义恢复的患者比例下降。这项研究支持在最长达 25mm 的指神经重建中使用 PNA 进行神经间隙重建。
研究类型/证据水平：治疗性 III 级。
