Orgel M G
Clin Plast Surg. 1984 Jan;11(1):101-4.
A survey of clinical and experimental work concerning the efficacy of epineurial versus perineurial suture techniques for the treatment of peripheral nerve disruption has been presented. It seems that little differences result from the utilization of either of these methods. Therefore, suture of the outer epineurium is the technique of choice for most acute nerve lacerations, since it is easier, faster, and requires less manipulation of the delicate internal neural structure. Clinical indications for outer epineurial or inner epineurial (group funicular) repair have also been discussed. The reasons why these techniques lead to similar results remain unclear. However, it would seem to be impossible to align individual axons if their vast numbers and the dynamic disruptive phenomena that occur after nerve transection are taken into account. It is now recognized that peripheral nerve regeneration studies must address events occurring at the level of the injury and additionally in the periphery and the cell body itself. The answer to the clinical problem of nerve transection will lie in our ability to manipulate axonal regeneration from the central nervous system to correct peripheral end organs. This question will not be solved by the position in which suture material is placed.
本文对关于神经外膜缝合与神经束膜缝合技术治疗周围神经断裂疗效的临床及实验研究进行了综述。似乎使用这两种方法中的任何一种所产生的差异都很小。因此，对于大多数急性神经撕裂伤，神经外膜缝合是首选技术，因为它更容易、更快，并且对精细的内部神经结构的操作更少。文中还讨论了神经外膜或神经束膜（束组）修复的临床适应证。这些技术产生相似结果的原因尚不清楚。然而，如果考虑到神经切断后大量的轴突以及发生的动态破坏现象，似乎不可能使单个轴突对齐。现在人们认识到，周围神经再生研究必须关注损伤部位以及外周和细胞体本身发生的事件。解决神经切断临床问题的答案在于我们操纵中枢神经系统轴突再生以纠正外周终末器官的能力。这个问题不会通过缝线材料的放置位置来解决。
