Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta, Canada.
Muscle Nerve. 2024 Dec;70(6):1151-1162. doi: 10.1002/mus.28262. Epub 2024 Sep 30.
Peripheral nerve injury is common and can have devastating consequences. In severe cases, functional recovery is often poor despite surgery. This is primarily due to the exceedingly slow rate of nerve regeneration at only 1-3 mm/day. The local environment in the distal nerve stump supportive of nerve regrowth deteriorates over time and the target end organs become atrophic. To overcome these challenges, investigations into treatments capable of accelerating nerve regrowth are of great clinical relevance and are an active area of research. One intervention that has shown great promise is perioperative electrical stimulation. Postoperative stimulation helps to expedite the Wallerian degeneration process and reduces delays caused by staggered regeneration at the site of nerve injury. By contrast, preoperative "conditioning" stimulation increases the rate of nerve regrowth along the nerve trunk. Over the past two decades, a rich body of literature has emerged that provides molecular insights into the mechanism by which electrical stimulation impacts nerve regeneration. The end result is upregulation of regeneration-associated genes in the neuronal body and accelerated transport to the axon front for regrowth. The efficacy of brief electrical stimulation on patients with peripheral nerve injuries was demonstrated in a number of randomized controlled trials on compressive, transection and traction injuries. As approved equipment to deliver this treatment is becoming available, it may be feasible to deploy this novel treatment in a wide range of clinical settings.
周围神经损伤很常见，可能会产生毁灭性的后果。在严重的情况下，尽管进行了手术，功能的恢复往往也很差。这主要是由于神经再生的速度极其缓慢，每天只有 1-3 毫米。随着时间的推移，远端神经残端的局部环境对神经再生的支持作用会恶化，靶终末器官会发生萎缩。为了克服这些挑战，研究能够加速神经再生的治疗方法具有重要的临床意义，也是一个活跃的研究领域。一种有很大希望的干预措施是围手术期电刺激。术后刺激有助于加速 Wallerian 变性过程，并减少因神经损伤部位的再生参差不齐而导致的延迟。相比之下，术前“预处理”刺激会增加沿神经主干的神经再生速度。在过去的二十年中，出现了大量的文献，为电刺激对神经再生的影响的机制提供了分子见解。其最终结果是神经元体内与再生相关的基因上调，并加速向轴突前缘的运输以进行再生。在一些关于压迫性、横断性和牵引性损伤的随机对照试验中，证明了短暂电刺激对周围神经损伤患者的疗效。随着可用于提供这种治疗的批准设备的出现，在广泛的临床环境中部署这种新的治疗方法可能是可行的。
