The Royal London Hospital, London, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
J Plast Reconstr Aesthet Surg. 2024 Oct;97:182-199. doi: 10.1016/j.bjps.2024.07.064. Epub 2024 Jul 30.
Peripheral nerve injuries (PNIs) are common, with complex defects posing a significant reconstructive challenge. Although vascularised (VNGs) and non-vascularised nerve grafts (NVNGs) are established treatment options, there is no comprehensive summary of the evidence supporting their clinical, electrophysiological, and histological outcomes. This review aims to systematically evaluate the clinical and laboratory literature comparing VNGs and NVNGs to inform future clinical practice and research.
This review was prospectively registered and reported according to PRISMA guidelines. PubMed, EMBASE, SCOPUS, and the Cochrane Register were systematically searched. Studies comparing VNGs and NVNGs in PNIs were included. Meta-analyses were performed for outcomes reported in ≥3 laboratory studies. Functional outcomes were synthesised by vote-counting based on direction of effect for clinical studies. Risk-of-bias was assessed using RoB2, ROBINS-I, and SYRCLE, and the certainty of evidence was evaluated using GRADE.
Seven clinical and 34 laboratory studies were included. Of the clinical comparisons, 90% and 56% identified an effect on recovery of sensibility (p = 0.01) and motor function (p = 0.05), respectively, that favoured VNGs. Nine (of 13) separate meta-analyses of laboratory studies demonstrated reduced muscular atrophy, superior axonal regeneration, and remyelination in VNGs. VNGs eliminated the 3-day interval of ischaemia otherwise sustained by NVNGs. Overall, the quality of evidence was low.
This systematic review indicates that VNGs may offer some advantages over NVNGs in PNI reconstruction. However, due to the low quality of evidence, significant statistical heterogeneity, and clinical diversity of the included studies, these conclusions should be interpreted with caution. Further high-quality clinical trials are necessary to validate these findings.
周围神经损伤（PNI）较为常见，复杂的缺损构成了重大的重建挑战。尽管带血管（VNG）和非带血管神经移植物（NVNG）是已确立的治疗选择，但目前尚无全面总结支持其临床、电生理和组织学结果的证据。本综述旨在系统评估比较 VNG 和 NVNG 的临床和实验室文献，以为未来的临床实践和研究提供信息。
本综述前瞻性注册并按 PRISMA 指南进行报告。系统检索了 PubMed、EMBASE、SCOPUS 和 Cochrane 登记处。纳入比较 PNI 中 VNG 和 NVNG 的研究。对报告≥3 项实验室研究的结果进行了荟萃分析。临床研究基于效应方向进行汇总，以投票计数法综合功能结果。使用 RoB2、ROBINS-I 和 SYRCLE 评估风险偏倚，并使用 GRADE 评估证据确定性。
纳入了 7 项临床研究和 34 项实验室研究。在临床比较中，90%和 56%的研究分别表明 VNG 有利于感觉恢复（p=0.01）和运动功能恢复（p=0.05）。9 项（共 13 项）单独的实验室研究荟萃分析表明，VNG 可减少肌肉萎缩、促进轴突再生和髓鞘形成。VNG 消除了 NVNG 维持的 3 天缺血间隔。总体而言，证据质量较低。
本系统综述表明，VNG 在 PNI 重建中可能优于 NVNG。然而，由于证据质量低、统计异质性大以及纳入研究的临床多样性，这些结论应谨慎解释。需要进一步开展高质量的临床试验来验证这些发现。
