Koller R, Rab M, Todoroff B P, Neumayer C, Haslik W, Stöhr H G, Frey M
Department of Surgery, Medical School, University of Vienna, Austria.
Br J Plast Surg. 1997 Dec;50(8):609-14. doi: 10.1016/s0007-1226(97)90506-3.
Clinical experience shows that the results after the use of long nerve grafts for reconstruction are sometimes poor. Nevertheless several authors have stressed that the concomitant big defect in the soft tissues necessitating the use of long grafts is the reason for some of the failures. In 22 rabbits the saphenous nerve was used as a nerve graft. Animals were separated into 3 groups with different lengths of the grafts, namely 3 cm (group 1), 5 cm (group 2) and 7 cm (group 3). In the left hindlimb the proximal end of the graft was coapted to the cut motor nerve branch of vastus medialis. In a second stage the distal end of the graft was coapted to the nerve branch of rectus femoris. After a total period of 15 months the maximum tetanic tension in the reinnervated rectus femoris and in the contralateral unoperated muscle was determined. Biopsies of the graft and the motor branch distal to the graft were taken in order to count the number of regenerated myelinated nerve fibers. The average maximum tetanic tension in the rectus femoris muscle reinnervated by the 3 cm long graft was 27.2 N, in group 2 the force was 20.5 N. In group 3 the maximum force was 17.6 N, which meant an average loss of 29% compared to the contralateral unoperated muscle. The mean number of regenerated myelinated fibres distal to the graft in the rectus femoris motor branch was 1683 in group 1 and decreased to 1137 in group 3. The results show that the length of the graft influences the results after nerve grafting to a certain extent, but a combination of other factors like concomitant soft tissue injury and destroyed target organs may also be responsible for some of the poor results after the clinical use of long nerve grafts.
临床经验表明，使用长神经移植物进行重建后的效果有时较差。然而，几位作者强调，需要使用长移植物的同时存在的软组织大缺损是部分失败的原因。在22只兔子中，使用隐神经作为神经移植物。将动物分为3组，每组移植物长度不同，分别为3厘米（第1组）、5厘米（第2组）和7厘米（第3组）。在左后肢，将移植物的近端与股内侧肌的切断运动神经分支吻合。在第二阶段，将移植物的远端与股直肌的神经分支吻合。在总共15个月的时间后，测定再支配的股直肌和对侧未手术肌肉的最大强直张力。对移植物和移植物远端的运动分支进行活检，以计数再生有髓神经纤维的数量。由3厘米长移植物再支配的股直肌的平均最大强直张力为27.2牛，第2组的力量为20.5牛。在第3组中，最大力量为17.6牛，这意味着与对侧未手术肌肉相比平均损失29%。股直肌运动分支中移植物远端再生有髓纤维的平均数量在第1组为1683条，在第3组减少到1137条。结果表明，移植物的长度在一定程度上影响神经移植后的效果，但其他因素的组合，如伴随的软组织损伤和靶器官破坏，也可能是临床使用长神经移植物后部分效果不佳的原因。
