Van Nest Duncan S, Kahan David M, Ilyas Asif M
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
J Hand Microsurg. 2021 Apr;13(2):49-54. doi: 10.1055/s-0040-1718651. Epub 2020 Dec 10.
Traumatic peripheral nerve injuries present a particular challenge to hand surgeons as mechanisms of nerve-healing pose serious limitations to achieving complete functional recovery. The loss of distal axonal segments through Wallerian degeneration results in the loss of neuromuscular junctions and irreversible muscle atrophy. Current methods of repair depend on the outgrowth of proximal nerve fibers following direct end-to-end repair or gap repair techniques. Investigational techniques in nerve repair using polyethylene glycol (PEG) nerve fusion have been shown to bypass Wallerian degeneration by immediately restoring nerve axonal continuity, thus resulting in a rapid and more complete functional recovery. The purpose of this article is to review the current literature surrounding this novel technique for traumatic nerve repair, paying particular attention to the underlying physiology of nerve healing and the current applications of PEG fusion in the laboratory and clinical setting. This article also serves to identify areas of future investigation to further establish validity and feasibility and encourage the translation of PEG fusion into clinical use.
创伤性周围神经损伤给手外科医生带来了特殊挑战，因为神经愈合机制对实现完全功能恢复构成了严重限制。沃勒变性导致远端轴突节段丧失，进而导致神经肌肉接头丧失和不可逆的肌肉萎缩。目前的修复方法依赖于直接端端修复或间隙修复技术后近端神经纤维的生长。已证明使用聚乙二醇（PEG）神经融合的神经修复研究技术可通过立即恢复神经轴突连续性来绕过沃勒变性，从而实现快速且更完全的功能恢复。本文的目的是回顾围绕这种创伤性神经修复新技术的当前文献，特别关注神经愈合的基础生理学以及PEG融合在实验室和临床环境中的当前应用。本文还旨在确定未来研究领域，以进一步确立其有效性和可行性，并鼓励将PEG融合转化为临床应用。
