Collagen nerve guides for surgical repair of brachial plexus birth injury
Collagen nerve guides for surgical repair of brachial plexus birth injury
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DOI：
10.3171/ped.2006.105.6.452
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发表时间：
2006-12-01
影响因子：
4.1
通讯作者：
Park, Tae Sung
中科院分区：
文献类型：
--
作者：
Ashley, William W., Jr.;Weatherly, Trisha;Park, Tae Sung
Object.标准的臂丛神经修复技术通常包括自体神经移植和神经移植。然而，当进行治疗严重损伤时，该程序有时会产生不良结果。此外，采集自体移植物是耗时的并且使患者暴露于额外的手术风险。为了改善手术结果并降低与自体神经移植物取出和放置相关的手术风险，作者使用胶原基质管（Neurogen）代替自体神经移植材料。在1991年至2005年期间，作者手术治疗了65名出生时患有臂丛神经损伤的婴儿。在此期间，7名患者使用胶原基质管（Neurogen）进行治疗。本研究是对最初使用插管治疗的5名患者的回顾性分析。两名患者最近接受了置管术，由于随访时间不充分而被排除在分析之外。5名患者中有4名患者术后2年恢复良好（运动评分复合评分[MSC] > 0.6），3名患者术后2年恢复良好（MSC > 0.75）。MSC在1年和2年时分别平均改善69%和78%。大多数患者的运动评分改善至大于或等于50%的活动度，挛缩通常为轻度或中度。后续的物理和职业治疗评估证实了这些患者的功能状态。当最后一次见到这些孩子时，其中五分之四的孩子可以自己吃饭和穿衣。从技术上讲，胶原基质管的使用简单有效，没有并发症。这个小系列的结果是令人鼓舞的。
Object. Standard brachial plexus repair techniques often involve autologous nerve graft placement and neurotization. However, when performed to treat severe injuries, this procedure can sometimes yield poor results. Moreover, harvesting the autologous graft is time-consuming and exposes the patient to additional surgical risks. To improve surgical outcomes and reduce surgical risks associated with autologous nerve graft retrieval and placement, the authors use collagen matrix tubes (Neurogen) instead of autologous nerve graft material.Methods. Between 1991 and 2005, the authors surgically treated 65 infants who had suffered brachial plexus injury at birth. During this time, seven patients were treated using collagen matrix tubes (Neurogen). This study is a retrospective analysis of the initial five patients who were treated using the tubes. Two patients underwent tube placement recently and were excluded from the analysis because of the inadequate follow-up period.Four of the five patients experienced a good recovery (motor scale composite [MSC] > 0.6), and three exhibited an excellent recovery (MSC > 0.75) at 2 years postoperatively. The MSC improved by an average of 69 and 78% at 1 and 2 years, respectively. The movement scores improved to greater than or equal to 50% range of motion in most patients, and the contractures were usually mild or moderate. Follow-up physical and occupational therapy evaluations confirm these patients' functional status. When last seen, four of five of these children could feed and dress themselves.Conclusions. Technically, the use of the collagen matrix tubes was straightforward and efficient, and there were no complications. The outcomes in this small series are encouraging.