Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.
Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong, China.
J Orthop Surg Res. 2023 Sep 12;18(1):675. doi: 10.1186/s13018-023-04076-x.
Surgical treatment of finger nerve injury is common for hand trauma. However, there are various surgical options with different functional outcomes. The aims of this study are to compare the outcomes of various finger nerve surgeries and to identify factors associated with the postsurgical outcomes via a systematic review and meta-analysis.
The literature related to digital nerve repairs were retrieved comprehensively by searching the online databases of PubMed from January 1, 1965, to August 31, 2021. Data extraction, assessment of bias risk and the quality evaluation were then performed. Meta-analysis was performed using the postoperative static 2-point discrimination (S2PD) value, moving 2-point discrimination (M2PD) value, and Semmes-Weinstein monofilament testing (SWMF) good rate, modified Highet classification of nerve recovery good rate. Statistical analysis was performed using the R (V.3.6.3) software. The random effects model was used for the analysis. A systematic review was also performed on the other influencing factors especially the type of injury and postoperative complications of digital nerve repair.
Sixty-six studies with 2446 cases were included in this study. The polyglycolic acid conduit group has the best S2PD value (6.71 mm), while the neurorrhaphy group has the best M2PD value (4.91 mm). End-to-side coaptation has the highest modified Highet's scoring (98%), and autologous nerve graft has the highest SWMF (91%). Age, the size of the gap, and the type of injury were factors that may affect recovery. The type of injury has an impact on the postoperative outcome of neurorrhaphy. Complications reported in the studies were mainly neuroma, cold sensitivity, paresthesia, postoperative infection, and pain.
Our study demonstrated that the results of surgical treatment of digital nerve injury are generally satisfactory; however, no nerve repair method has absolute advantages. When choosing a surgical approach to repair finger nerve injury, we must comprehensively consider various factors, especially the gap size of the nerve defect, and postoperative complications. Type of study/level of evidence Therapeutic IV.
手部创伤常需进行手指神经手术治疗。然而，各种手术方法的功能结果存在差异。本研究旨在通过系统评价和荟萃分析，比较各种手指神经手术的结果，并确定与术后结果相关的因素。
通过检索 PubMed 在线数据库，全面检索 1965 年 1 月 1 日至 2021 年 8 月 31 日有关指神经修复的文献。然后进行数据提取、偏倚风险评估和质量评价。使用术后静态 2 点辨别觉（S2PD）值、移动 2 点辨别觉（M2PD）值、Semmes-Weinstein 单丝试验（SWMF）良好率、改良 Highet 神经恢复良好率进行荟萃分析。使用 R（V.3.6.3）软件进行统计分析。分析采用随机效应模型。还对其他影响因素，特别是指神经修复的损伤类型和术后并发症进行了系统评价。
本研究共纳入 66 项研究，2446 例患者。聚乙醇酸导管组 S2PD 值最佳（6.71mm），神经吻合组 M2PD 值最佳（4.91mm）。端侧吻合术改良 Highet 评分最高（98%），自体神经移植 SWMF 最高（91%）。年龄、间隙大小和损伤类型是可能影响恢复的因素。损伤类型对神经吻合术的术后结果有影响。研究中报告的并发症主要有神经瘤、冷感、感觉异常、术后感染和疼痛。
本研究表明，手部神经损伤的手术治疗结果总体上是令人满意的，但没有一种神经修复方法具有绝对优势。在选择修复手指神经损伤的手术方法时，必须综合考虑各种因素，尤其是神经缺损的间隙大小和术后并发症。研究类型/证据水平治疗 IV。
