Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan.
Clin Neurol Neurosurg. 2021 Oct;209:106920. doi: 10.1016/j.clineuro.2021.106920. Epub 2021 Aug 28.
Nerve capping treatment using bioabsorbable nerve conduits has recently been introduced for painful amputation neuroma. However, no clinical or experimental data are available for comparing nerve conduits with open distal ends and closed distal ends. Here, we investigated the nerve conduit with open or closed distal ends as the superior capping device, using a commercially available polyglycolic acid (PGA) nerve conduit in a rat sciatic nerve amputation model.
Ninety-one rats were assigned to three groups: no-capping (n = 30), capping the resected nerve stump with open ends (n = 31), and closed-end nerve conduits (n = 30). Twelve weeks after sciatic neurectomy, with or without capping, the evaluation of neuropathic pain using the autotomy score was performed. Stump neuromas with perineural scars and neuroinflammation were evaluated histologically.
The mean autotomy scores in the closed-end nerve conduit group were significantly lower than those in the no-capping group. However, the difference between the open-end nerve conduit and the closed-end nerve conduit groups was insignificant. Histologically, distal axonal fibers expanded radially and formed neuromas in the no-capping group while they were terminated within the PGA conduit in both capping groups. In particular, the closed-end version of the PGA nerve conduit blocked scarring from intruding through the open end and protected the nerve stump with less neuroinflammation. Nerve capping with the closed-end version of the PGA nerve conduit most effectively suppressed perineural neuroinflammation and scar formation around the resected nerve stump.
Nerve capping with the PGA nerve conduit, particularly those with closed ends, after rat sciatic neurectomy prevented amputation neuroma and relieved neuropathic pain.
使用可吸收神经导管进行神经套盖处理最近已被引入用于治疗疼痛性截肢神经瘤。然而，目前尚无比较开放式和封闭式远端神经导管的临床或实验数据。在这里，我们使用市售的聚乙醇酸（PGA）神经导管，在大鼠坐骨神经切断模型中，研究了开放式和封闭式远端神经导管作为套盖装置的效果。
91 只大鼠被分为三组：无套盖组（n=30）、开放式神经导管套盖组（n=31）和封闭式神经导管组（n=30）。坐骨神经切断后 12 周，评估有无套盖情况下，自截评分法评估神经病理性疼痛。评估神经瘤周围神经外膜瘢痕和神经炎症的组织学变化。
封闭式神经导管组的平均自截评分明显低于无套盖组。然而，开放式神经导管组与封闭式神经导管组之间的差异无统计学意义。组织学上，无套盖组的远端轴突纤维呈放射状扩张并形成神经瘤，而在套盖组中，这些纤维都终止在 PGA 导管内。特别是，PGA 神经导管的封闭式版本阻止了瘢痕从开口处侵入，并通过减少神经炎症来保护神经残端。与开放式神经导管相比，PGA 神经导管的封闭式版本更有效地抑制了切除神经残端周围的神经外膜神经炎症和瘢痕形成。
大鼠坐骨神经切断后，PGA 神经导管套盖，特别是封闭式神经导管套盖，可预防截肢神经瘤并缓解神经病理性疼痛。
