From the Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Ann Plast Surg. 2021 Aug 1;87(2):179-186. doi: 10.1097/SAP.0000000000002823.
Peripheral nerve injuries (PNIs) are most commonly treated with direct nerve repair procedures or nerve autografts. However, recent advancements in synthetic and vein conduits have led to their increased utilization. The present study quantifies the incidence of these procedures over time and geography and identifies differences in complication rates, illustrating the current epidemiologic climate regarding conduit use for PNI repair.
A query was conducted using the State Ambulatory Surgery and Services Databases data from 2006 to 2011 in both Florida and California for patients undergoing nerve repair, nerve grafting, synthetic conduits, and vein conduits. Patient zip code data were analyzed to determine the geographic distribution of various types of repair. In addition, text-mining algorithms were used to identify trends in PNI-related publications.
In the 6-year period investigated, direct nerve repair was the most frequently used procedure for PNIs. However, the utilization of direct repairs declined significantly from 2006 to 2011. Synthetic and vein conduits demonstrated a significant increase over the same period. There were significantly higher rates of complications for autologous grafts (3.3%), vein conduits (3.5%), and synthetic conduits (2.4%), as compared with direct nerve repairs (1.4%). There was a nonsignificant difference in infection rates between these types of nerve repair.
From an epidemiologic perspective, both graft and synthetic conduit-based PNI repairs are increasing in prevalence both in clinical practice and in the academic literature. This will likely continue in the future with the development of advancements in biologic and synthetic nerve conduit PNI repair options.
周围神经损伤（PNI）的治疗方法通常为直接神经修复术或神经自体移植术。然而，最近在合成和静脉导管方面的进展导致它们的应用日益增加。本研究通过量化这些手术随时间和地域的应用变化，并比较并发症发生率的差异，阐明了当前导管在周围神经损伤修复方面的流行病学情况。
使用 2006 年至 2011 年佛罗里达州和加利福尼亚州的州门诊手术和服务数据库的数据，对接受神经修复、神经移植、合成导管和静脉导管治疗的患者进行了查询。对患者邮政编码数据进行分析，以确定各种修复类型的地域分布。此外，还使用文本挖掘算法来确定与 PNI 相关的出版物的趋势。
在所研究的 6 年期间，直接神经修复是周围神经损伤最常用的手术方法。然而，从 2006 年到 2011 年，直接修复的使用率显著下降。同期，合成导管和静脉导管的使用率显著增加。与直接神经修复（1.4%）相比，自体移植物（3.3%）、静脉导管（3.5%）和合成导管（2.4%）的并发症发生率明显更高。这些神经修复类型之间的感染率无显著差异。
从流行病学的角度来看，在临床实践和学术文献中，基于移植物和合成导管的周围神经损伤修复的应用都在增加。随着生物和合成神经导管周围神经损伤修复选择的发展，这种趋势在未来可能还会继续。
