Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.
Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK.
Sci Rep. 2023 Sep 13;13(1):15175. doi: 10.1038/s41598-023-42230-x.
Quantification of peripheral nerve regeneration after injury relies upon subjective outcome measures or electrophysiology assessments requiring fully regenerated neurons. Nerve surgeons and researchers lack objective, quantifiable information on the site of surgical repair and regenerative front. To address this need, we developed a quantifiable, visual, clinically available measure of early peripheral nerve regeneration using high-frequency, three-dimensional, tomographic ultrasound (HFtUS). We conducted a prospective, longitudinal study of adult patients with ulnar and/or median nerve injury of the arm undergoing direct epineurial repair within 5 days of injury. Assessment of morphology, volumetric and 3D grey-scale quantification of cross-sectional views were made at baseline up to 15 months post-surgery. Sensory and motor clinical outcome measures and patient reported outcome measures (PROMs) were recorded. Five participants were recruited to the study. Our data demonstrated grey-scale values (an indication of axonal density) increased in distal stumps within 2-4 months after repair, returning to normal as regeneration completed (4-6 months) with concomitant reduction in intraneural volume as surgical oedema resolved. Two patients with abnormal regeneration were characterized by increased intraneural volume and minimal grey-scale change. HFtUS may quantify early peripheral nerve regeneration offering a window of opportunity for surgical intervention where early abnormal regeneration is detected.
神经损伤后外周神经再生的量化依赖于主观的结果评估或需要完全再生神经元的电生理学评估。神经外科医生和研究人员缺乏关于手术修复部位和再生前沿的客观、可量化的信息。为了满足这一需求，我们使用高频三维断层超声（HFtUS）开发了一种可量化、可视化、临床可用的早期外周神经再生测量方法。我们对在损伤后 5 天内接受直接神经外膜修复的上肢尺神经和/或正中神经损伤的成年患者进行了前瞻性、纵向研究。在基线时以及术后 15 个月内对形态学、体积和横断面的 3D 灰阶定量进行评估。记录了感觉和运动临床结果评估和患者报告结果评估（PROMs）。研究招募了 5 名参与者。我们的数据表明，修复后 2-4 个月内远端残端的灰阶值（轴突密度的指示）增加，随着再生完成（4-6 个月），神经内体积减少，同时手术水肿消退，灰阶值恢复正常。2 例再生异常的患者表现为神经内体积增加和灰阶变化极小。HFtUS 可量化早期外周神经再生，为早期异常再生时的手术干预提供了机会。
