Nerve-End Capping Treatment with a Polyglycolic Acid Conduit for Rat Sciatic Neuroma: A Preliminary Report
Nerve-End Capping Treatment with a Polyglycolic Acid Conduit for Rat Sciatic Neuroma: A Preliminary Report
复制标题
DOI：
10.1055/s-0042-1757208
复制
发表时间：
2022-09-19
影响因子：
2.1
通讯作者：
Nakamura，Hiroaki
中科院分区：
文献类型：
--
作者：
Onode，Ema;Uemura，Takuya;Nakamura，Hiroaki
背景痛性神经瘤的治疗仍然具有挑战性。最近，一种使用生物可吸收神经导管的神经末梢盖帽技术被新近引入治疗截肢神经瘤。胶原蛋白包裹的聚乙醇酸(PGA)导管已用于周围神经缺损的重建，并取得了成功的临床结果。然而，将这种PGA神经导管用作截肢神经瘤的封闭器还没有进行过实验研究。方法47只大鼠随机分为两组：未封盖组( 组，n=25)和胶原组(PGA神经导管盖盖组，n= ，n=22)。坐骨神经切除12周后，用自体神经切断评分评估神经病理性疼痛。对残端神经瘤进行组织学评估或神经周围瘢痕和神经炎症。结果两组患者术后4周、8周和12周的自体神经切除评分逐渐加重，而盖盖组的评分一直较低。术后12周，未封盖组切断的神经残端已形成与周围组织紧密附着的肉眼可见的球状神经瘤，而封盖组神经导管仍包裹着松散附着于周围组织的PGA神经导管。组织学上，未封盖组远端轴突纤维呈放射状扩张并形成神经瘤，而封盖组远端轴突纤维终止于PGA管道内。未封盖组随机出芽神经末梢周围广泛可见神经周瘢痕和神经炎症。结论大鼠坐骨神经切除后，神经末梢用胶原蛋白包裹的PGA导管进行神经末梢封闭，可能通过抑制神经周围瘢痕的形成和神经残端周围的神经炎症来预防神经瘤的形成，具有潜在的缓解神经病理性疼痛的作用。
BackgroundThe treatment of painful neuroma remains challenging. Recently, a nerve-end capping technique using a bioabsorbable nerve conduit was newly introduced to treat amputation neuroma. A collagen-coated polyglycolic acid (PGA) conduit has been commercially available for the reconstruction of peripheral nerve defects, yielding successful clinical outcomes. However, no experimental research has been conducted using this PGA nerve conduit as capping device for treating amputation neuroma. The purpose of this study was to investigate nerve-end capping treatment with the PGA conduit in the rat sciatic nerve amputation model, focusing on histological scar formation and neuroinflammation.MethodsForty-seven rats were divided into two groups: no capping (transected nerve stump without capping;n= 25) and capping (nerve-end capping with collagen-coated PGA nerve conduit;n= 22). Twelve weeks after sciatic neurectomy, neuropathic pain was evaluated using the autotomy score. Stump neuromas were histologically evaluated or perineural scar and neuroinflammation.ResultsWhile autotomy scores gradually exacerbated in both groups, they were consistently lower in the capping group at 4, 8, and 12 weeks postprocedure. Twelve weeks after surgery, the transected nerve stumps in the no-capping group had formed macroscopic bulbous neuromas strongly adhering to surrounding tissues, whereas they remained wrapped with the PGA nerve conduits loosely adhering to surrounding tissues in the capping group. Histologically, distal axonal fibers were expanded radially and formed neuromas in the no-capping group, while they were terminated within the PGA conduit in the capping group. Perineural scars and neuroinflammation were widely found surrounding the randomly sprouting nerve end in the no-capping group. In capped counterparts, scars and inflammation were limited to closely around the terminated nerve end.ConclusionNerve-end capping with a collagen-coated PGA conduit after rat sciatic neurectomy might prevent neuroma formation by suppressing perineural scar formation and neuroinflammation around the nerve stump, potentially relieving neuropathic pain.