Beale Suzanne, Duraku Liron S, McGhee Christopher C G, van der Oest Mark, Rotem Gilad, Power Dominic M
From the Birmingham Hand Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Amsterdam University Medical Centre, Dept. Plastic, Reconstructive & Hand Surgery, Amsterdam, Netherlands.
Plast Reconstr Surg Glob Open. 2024 Aug 30;12(8):e6111. doi: 10.1097/GOX.0000000000006111. eCollection 2024 Aug.
Following the repair of a mixed peripheral nerve, functional recovery requires successful nerve regeneration across the repair site and, eventually, reinnervation of distal targets. Reliably determining a failing nerve repair so that revision may be performed before irreversible muscle atrophy remains a challenge in peripheral nerve surgery. This study aimed to ascertain whether any commonly used clinical examination tests during surveillance after nerve repair can detect a failing repair and prompt earlier salvage intervention.
A prospective observational cohort study was performed to evaluate commonly used clinical determinants of neuron regeneration that may provide early surrogate recovery measures. Sequential cutaneous thermography was used to identify temperature differences between denervated and normal skin in the hand operated on, with the contralateral hand as a control.
Six out of nine patients completed between 6 and 18 months of follow-up. Tinel sign progression was observed in all subjects. Tinel progression rate was associated with motor and sensory Medical Research Council grade. The delta temperature was calculated to document the size and direction of any temperature differentials in the hand detected by thermography, but we did not have sufficient data to calculate any correlations with motor and sensory Medical Research Council grade.
Specifically, the progression of Tinel sign is associated with recovery measured by progression of the British Medical Research Council motor and sensory grades. The use of thermographic imaging demonstrates that there is a difference in temperature between an injured and noninjured nerve. Future studies could investigate to what extent thermographic imaging predicts final nerve repair outcomes.
在混合性周围神经修复后，功能恢复需要神经在修复部位成功再生，并最终实现对远端靶器官的重新支配。在外周神经手术中，可靠地确定神经修复失败以便在不可逆的肌肉萎缩发生之前进行翻修仍然是一项挑战。本研究旨在确定神经修复后监测期间常用的临床检查测试是否能够检测到修复失败并促使更早地进行挽救性干预。
进行了一项前瞻性观察队列研究，以评估可能提供早期替代恢复指标的常用神经元再生临床决定因素。采用连续皮肤温度成像技术来识别手术手去神经支配皮肤与正常皮肤之间的温度差异，对侧手作为对照。
9名患者中有6名完成了6至18个月的随访。所有受试者均观察到Tinel征进展。Tinel征进展率与运动和感觉医学研究委员会分级相关。计算温度差值以记录通过热成像检测到手部任何温度差异的大小和方向，但我们没有足够的数据来计算其与运动和感觉医学研究委员会分级的相关性。
具体而言，Tinel征的进展与英国医学研究委员会运动和感觉分级进展所衡量的恢复情况相关。热成像的使用表明受伤神经与未受伤神经之间存在温度差异。未来的研究可以调查热成像在多大程度上能够预测最终的神经修复结果。
