Nerve repair, grafting, and nerve transfers
Nerve repair, grafting, and nerve transfers
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DOI：
10.1016/s0094-1298(02)00096-2
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发表时间：
2003-04-01
影响因子：
2.3
通讯作者：
Mackinnon, S
中科院分区：
文献类型：
--
作者：
Dvali, L;Mackinnon, S
直到18世纪末，人们才认为周围神经损伤后无法再生[1]。从那时起，我们对周围神经损伤和修复的理解取得了巨大进步。神经再生和目标神经支配的过程很复杂，涉及多种因素。如果细胞体未能从最初的损伤中幸存下来或无法启动再生，则神经再生不会开始。远端神经残端必须提供适当的环境来支持再生。最后，再生的轴突必须及时到达并重新支配适当的目标终末器官。全面了解周围神经解剖学、生理学和病理生理学对于获得最佳结果至关重要。许多其他因素影响神经修复或重建的成功。修复的时机、损伤的程度、损伤区域的范围、外科医生的技术以及修复或重建的方法都会影响神经损伤后的功能结果。本文回顾了神经修复的原理和技术，并讨论了直接修复的选择，包括神经移植、导管、端侧修复和神经间转移。
Until the late 18th century, it was felt that peripheral nerves did not regenerate after injury [1]. Since that time, tremendous advances have been made in our understanding of peripheral nerve injury and repair. The processes of nerve regeneration and target reinnervation are complex and involve multiple factors. Nerve regeneration does not begin if the cell body has not survived the initial injury or if it is unable to initiate regeneration. The distal nerve stump must then provide the appropriate environment to support regeneration. Finally, the regenerated axons must reach and reinnervate the appropriate target end-organs in a timely fashion. A thorough knowledge of peripheral nerve anatomy, physiology, and pathophysiology is critical to obtaining optimal results.Many additional factors influence the success of nerve repair or reconstruction. The timing of the repair, the level of the injury, the extent of the zone of injury, the technical skill of the surgeon, and the method of repair or reconstruction contribute to the functional outcome after nerve injury. This article reviews the principles and techniques of nerve repair and discusses the options to direct repair, including nerve grafts, conduits, end-to-side repair, and nerve-to-nerve transfers.