From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine; and Department of Plastic and Reconstructive Surgery, The Ohio State University, Wexner Medical Center.
Plast Reconstr Surg. 2022 Apr 1;149(4):681e-690e. doi: 10.1097/PRS.0000000000008924.
Repair of nerve injuries can fail to achieve adequate functional recovery. Electrical stimulation applied at the time of nerve repair can accelerate axon regeneration, which may improve the likelihood of recovery. However, widespread use of electrical stimulation may be limited by treatment protocols that increase operative time and complexity. This study evaluated whether a short-duration electrical stimulation protocol (10 minutes) was efficacious to enhance regeneration following nerve repair using rat models.
Lewis and Thy1-green fluorescent protein rats were randomized to three groups: 0 minutes of electrical stimulation (no electrical stimulation; control), 10 minutes of electrical stimulation, and 60 minutes of electrical stimulation. All groups underwent tibial nerve transection and repair. In the intervention groups, electrical stimulation was delivered after nerve repair. Outcomes were assessed using immunohistochemistry, histology, and serial walking track analysis.
Two weeks after nerve repair, Thy1-green fluorescent protein rats demonstrated increased green fluorescent protein-positive axon outgrowth from the repair site with electrical stimulation compared to no electrical stimulation. Serial measurement of walking tracks after nerve repair revealed recovery was achieved more rapidly in both electrical stimulation groups as compared to no electrical stimulation. Histologic analysis of nerve distal to the repair at 8 weeks revealed robust axon regeneration in all groups.
As little as 10 minutes of intraoperative electrical stimulation therapy increased early axon regeneration and facilitated functional recovery following nerve transection with repair. Also, as early axon outgrowth increased following electrical stimulation with nerve repair, these findings suggest electrical stimulation facilitated recovery because of earlier axon growth across the suture-repaired site into the distal nerve to reach end-organ targets.
Brief (10-minute) electrical stimulation therapy can provide similar benefits to the 60-minute protocol in an acute sciatic nerve transection/repair rat model and merit further studies, as they represent a translational advantage.
神经损伤的修复可能无法实现足够的功能恢复。在神经修复时施加电刺激可以加速轴突再生，这可能提高恢复的可能性。然而，广泛使用电刺激可能会受到增加手术时间和复杂性的治疗方案的限制。本研究评估了使用大鼠模型，神经修复后 10 分钟的短时间电刺激方案是否有效增强再生。
Lewis 和 Thy1-绿色荧光蛋白大鼠随机分为三组：0 分钟电刺激（无电刺激；对照）、10 分钟电刺激和 60 分钟电刺激。所有组均进行胫骨神经横断和修复。在干预组中，在神经修复后给予电刺激。使用免疫组织化学、组织学和连续行走轨迹分析评估结果。
神经修复后 2 周，电刺激组与无电刺激组相比，Thy1-绿色荧光蛋白大鼠的修复部位有更多的绿色荧光蛋白阳性轴突生长。神经修复后连续行走轨迹测量显示，两个电刺激组的恢复速度均比无电刺激组更快。8 周时神经修复远端的组织学分析显示所有组均有大量轴突再生。
术中电刺激治疗仅 10 分钟即可增加神经横断修复后的早期轴突再生并促进功能恢复。此外，由于电刺激后神经修复时早期轴突生长增加，这些发现表明电刺激通过更早地在缝合修复部位穿过轴突生长进入远端神经到达终末器官靶标来促进恢复。
在急性坐骨神经横断/修复大鼠模型中，短暂（10 分钟）电刺激治疗可以提供与 60 分钟方案相似的益处，值得进一步研究，因为它们代表了一种转化优势。
