Pereira Clifford T, Hill Elise E, Stasyuk Anastasiya, Parikh Neil, Dhillon Jannat, Wang Aijun, Li Andrew
Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA.
Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA.
J Clin Med. 2023 Feb 16;12(4):1555. doi: 10.3390/jcm12041555.
Peripheral nerve injuries requiring surgical repair affect over 100,000 individuals in the US annually. Three accepted methods of peripheral repair include end-to-end, end-to-side, and side-to-side neurorrhaphy, each with its own set of indications. While it remains important to understand the specific circumstances in which each method is employed, a deeper understanding of the molecular mechanisms underlying the repair can add to the surgeon's decision-making algorithm when considering each technique, as well as help decide nuances in technique such as the need for making epineurial versus perineurial windows, length and dept of the nerve window, and distance from target muscle. In addition, a thorough knowledge of individual factors that are active in a particular repair can help guide research into adjunct therapies. This paper serves to summarize the similarities and divergences of the three commonly used nerve repair strategies and the scope of molecular mechanisms and signal transduction pathways in nerve regeneration as well as to identify the gaps in knowledge that should be addressed if we are to improve clinical outcomes in our patients.
在美国，每年有超过10万人需要进行外科修复的周围神经损伤。三种公认的周围神经修复方法包括端端、端侧和侧侧神经缝合术，每种方法都有其特定的适应症。虽然了解每种方法的具体应用情况仍然很重要，但深入了解修复背后的分子机制可以在外科医生考虑每种技术时增加其决策算法的依据，也有助于确定技术细节，如是否需要制作神经外膜窗与神经束膜窗、神经窗的长度和深度以及与目标肌肉的距离。此外，全面了解特定修复过程中起作用的个体因素有助于指导辅助治疗的研究。本文旨在总结三种常用神经修复策略的异同、神经再生中分子机制和信号转导通路的范围，并确定如果我们要改善患者的临床结果，应该解决的知识空白。
