Onode Ema, Uemura Takuya, Takamatsu Kiyohito, Yokoi Takuya, Hama Shunpei, Miyashima Yusuke, Saito Kosuke, Okada Mitsuhiro, Nakamura Hiroaki
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan; Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzakicho, Abeno-ku, Osaka 545-0053, Japan.
J Plast Reconstr Aesthet Surg. 2025 Sep;108:43-52. doi: 10.1016/j.bjps.2025.07.005. Epub 2025 Jul 11.
Bioabsorbable nerve conduits have recently emerged as alternatives to autologous nerve grafts in peripheral nerve defects. Two types of nerve conduits have thus far been approved for clinical use in Japan: a polyglycolic acid (PGA) conduit and a collagen conduit. However, no studies have yet compared their efficacy in peripheral nerve reconstruction. This study aimed preliminarily to compare the efficacy of three bioabsorbable nerve conduits, PGA and collagen conduits, and a poly-L-lactide and polycaprolactone (PLA/PCL) conduit, in a rat sciatic nerve gap model.
Twenty-three rats were assigned to five treatment groups: control (no treatment), PGA conduit, collagen conduit, PLA/PCL conduit, and autograft. Functional recovery was assessed based on improvements in the sciatic functional index (SFI) and histological gastrocnemius muscle atrophy. Axonal regeneration and the luminal structure of the conduits were evaluated histologically 12 weeks post-treatment.
The PLA/PCL conduit group exhibited superior functional recovery compared to the PGA and collagen groups, but slightly inferior results to the autograft group. Axonal regeneration was greater in the PLA/PCL group compared to the PGA and collagen groups, and comparable to the autograft group. In the PLA/PCL group, only the inner layer of the lumen was rapidly absorbed, while the outer layer remained due to its very slow degradation, ultimately allowing the lumen to expand. The PLA/PCL conduit maintained luminal stability without collapsing, unlike the PGA and collagen conduits, which showed significant narrowing due to material degradation.
The PLA/PCL nerve conduit demonstrated superior axonal regeneration and functional recovery preliminarily compared to PGA and collagen conduits, attributable to its slower degradation and superior maintenance of the luminal structure, indicating its potential as an effective alternative to autologous nerve grafts.
生物可吸收神经导管最近已成为周围神经缺损中自体神经移植的替代物。迄今为止，有两种类型的神经导管已在日本获批用于临床：聚乙醇酸（PGA）导管和胶原导管。然而，尚无研究比较它们在周围神经重建中的疗效。本研究旨在初步比较三种生物可吸收神经导管，即PGA导管、胶原导管和聚-L-乳酸与聚己内酯（PLA/PCL）导管，在大鼠坐骨神经缺损模型中的疗效。
将23只大鼠分为五个治疗组：对照组（未治疗）、PGA导管组、胶原导管组、PLA/PCL导管组和自体移植组。根据坐骨神经功能指数（SFI）的改善情况和组织学上腓肠肌萎缩情况评估功能恢复。在治疗后12周，通过组织学评估轴突再生和导管的管腔结构。
与PGA组和胶原组相比，PLA/PCL导管组表现出更好的功能恢复，但略逊于自体移植组。与PGA组和胶原组相比，PLA/PCL组的轴突再生更多，且与自体移植组相当。在PLA/PCL组中，仅管腔的内层迅速被吸收，而外层由于降解非常缓慢而保留下来，最终使管腔扩张。与PGA导管和胶原导管不同，PLA/PCL导管保持了管腔稳定性而不塌陷，PGA导管和胶原导管由于材料降解而出现明显狭窄。
与PGA导管和胶原导管相比，PLA/PCL神经导管初步显示出更好的轴突再生和功能恢复，这归因于其较慢的降解和对管腔结构的更好维持，表明其作为自体神经移植有效替代物的潜力。
