Lans Jonathan, Eberlin Kyle R, Evans Peter J, Mercer Deana, Greenberg Jeffrey A, Styron Joseph F
From the Department of Orthopaedic Surgery, Hand and Upper Extremity Service.
Division of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, Massachusetts General Hospital, Harvard Medical School.
Plast Reconstr Surg. 2023 May 1;151(5):814e-827e. doi: 10.1097/PRS.0000000000010088. Epub 2022 Dec 26.
Ideal nerve repair involves tensionless direct repair, which may not be possible after resection. Bridging materials include nerve autograft, allograft, or conduit. This study aimed to perform a systematic literature review and meta-analysis to compare the meaningful recovery (MR) rates and postoperative complications following autograft, allograft, and conduit repairs in nerve gaps greater than 5 mm and less than 70 mm. A secondary aim was to perform a comparison of procedure costs.
The search was conducted in MEDLINE from January of 1980 to March of 2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included whether they reported nerve injury type, repair type, gap length, and outcomes for MR rates. Thirty-five studies with 1559 nerve repairs were identified.
Overall MR for sensory and motor function was not significantly different between autograft ( n = 670) and allograft ( n = 711) across both short and long gaps. However, MR rates for autograft (81.6%) and allograft (87.1%) repairs were significantly higher compared with conduits (62.2%) ( P < 0.05) in sensory short gap repairs. Complication rates were comparable for autograft and allograft but higher for conduit with regard to pain. Analysis of costs showed that total costs for allograft repair were less than autograft in the inpatient setting and were comparable in the outpatient setting.
Literature showed comparable rates of MR between autograft and allograft, regardless of gap length or nerve type. Furthermore, the rates of MR were lower in conduit repairs. In addition, the economic analysis performed demonstrates that allograft does not represent an increased economic burden compared with autograft.
理想的神经修复需要无张力直接修复，而在切除术后可能无法实现。桥接材料包括神经自体移植、同种异体移植或导管。本研究旨在进行系统的文献综述和荟萃分析，以比较自体移植、同种异体移植和导管修复在5mm至70mm神经缺损后的有意义恢复（MR）率和术后并发症。第二个目的是比较手术成本。
按照系统评价和荟萃分析的首选报告项目指南，于1980年1月至2020年3月在MEDLINE中进行检索。纳入报告神经损伤类型、修复类型、缺损长度和MR率结果的研究。共识别出35项研究，涉及1559例神经修复。
在短间隙和长间隙中，自体移植（n = 670）和同种异体移植（n = 711）之间感觉和运动功能的总体MR无显著差异。然而，在感觉短间隙修复中，自体移植（81.6%）和同种异体移植（87.1%）修复的MR率显著高于导管修复（62.2%）（P < 0.05）。自体移植和同种异体移植的并发症发生率相当，但导管修复在疼痛方面更高。成本分析表明，在住院环境中，同种异体移植修复的总成本低于自体移植，在门诊环境中两者相当。
文献表明，无论间隙长度或神经类型如何，自体移植和同种异体移植的MR率相当。此外，导管修复的MR率较低。此外，进行的经济分析表明，与自体移植相比，同种异体移植不会增加经济负担。
