Neurological Recovery Across a 12-cm-Long Ulnar Nerve Gap Repaired 3.25 Years Post Trauma: Case Report
Neurological Recovery Across a 12-cm-Long Ulnar Nerve Gap Repaired 3.25 Years Post Trauma: Case Report
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DOI：
10.1227/neu.0b013e31822a9fd2
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发表时间：
2011-12-01
期刊：
影响因子：
4.8
通讯作者：
Martins, Roberto S.
中科院分区：
文献类型：
--
作者：
Kuffler, Damien P.;Reyes, Onix;Martins, Roberto S.
背景和重要性：修复周围神经间隙的标准临床技术是使用自体感觉神经移植物。本研究测试了充满自体富血小板纤维蛋白的胶原蛋白管是否可以诱导创伤后 3.25 年修复的 12 厘米神经间隙的感觉和运动恢复，并减少或消除神经性疼痛。临床表现：修复两年后，无名指和小指已发展出良好的运动功能，可产生 1 公斤的力，并且小指和无名指以及近端而非远端腕部已发展出地形正确的 2 点辨别和对振动的敏感性。患者的剧烈神经性疼痛已减轻至可以忍受的程度，并且避免了截肢。 12 厘米长的神经间隙用充满自体富血小板纤维蛋白的胶原管桥接。 结论：我们证明，填充富血小板纤维蛋白的导管可以在创伤后 3.25 年修复的 12 厘米神经间隙上诱导有限但适当的感觉和运动恢复，而不牺牲感觉神经，可以将现有的难以忍受的神经性疼痛减轻到可忍受的程度，并允许避免指示性疼痛上肢截肢。我们相信该技术可以得到改进，以诱导更广泛和可靠的神经恢复。
BACKGROUND AND IMPORTANCE: The standard clinical technique for repairing peripheral nerve gaps is the use of autologous sensory nerve grafts. The present study tested whether a collagen tube filled with autologous platelet-rich fibrin could induce sensory and motor recovery across a 12-cm nerve gap repaired 3.25 years post trauma, and reduce or eliminate neuropathic pain.CLINICAL PRESENTATION: Two years postrepair, good ring and small finger motor function had developed that could generate 1 kg of force, and topographically correct 2-point discrimination and sensitivity to vibration in the small and ring finger and proximal but not distal wrist had developed. The patient's excruciating neuropathic pain was reduced to tolerable, and he avoided the indicated extremity amputation. The 12-cm-long nerve gap was bridged with a collagen tube filled with autologous platelet-rich fibrin.CONCLUSION: We demonstrate that a conduit filled with platelet-rich fibrin can induce limited, but appropriate, sensory and motor recovery across a 12-cm nerve gap repaired 3.25 years post trauma, without sacrificing a sensory nerve, can reduce existing excruciating neuropathic pain to tolerable, and allow avoidance of an indicated upper-extremity amputation. We believe the technique can be improved to induce more extensive and reliable neurological recovery.