Radial nerve repair using an autologous denatured muscle graft: comparison with outcomes of nerve graft repair
Radial nerve repair using an autologous denatured muscle graft: comparison with outcomes of nerve graft repair
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DOI：
10.1007/s00701-007-1269-z
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发表时间：
2007-10-01
影响因子：
2.4
通讯作者：
Savic, M.
中科院分区：
文献类型：
--
作者：
Roganovic, Z.;Ilic, S.;Savic, M.
背景资料。变性肌肉移植在神经修复中的有效性已在实验模型和动物中得到证实。修复数字神经和混合感觉-运动神经的第一次临床试验在感觉恢复方面令人鼓舞，但运动恢复很差，可能是因为修复延迟。我们介绍了使用变性肌肉移植修复运动神经的功能结果，并与使用标准神经移植技术的结果进行了比较。这项前瞻性研究包括用变性肌肉移植修复9例尺神经缺损和23例用神经移植修复的桡神经缺损。弹射性神经损伤、病变位于臂中部、神经间隙小于6 cm、术前间隔小于5个月是所有患者的共同特征。所有患者均未合并血管损伤、严重瘢痕形成或神经修复区域的显著软组织损伤。根据BMRC评分，术后至少4.7年，运动恢复评分为0-5分。在使用肌肉移植的9名患者中有7名获得了成功的结果(P>；=M3)，在使用神经移植的23名患者中有21名获得了成功(P>；0.05)。使用肌肉移植治疗的患者从未获得良好的恢复和临床上有意义的拇指伸展(M5级)重建。神经移植组的平均运动评分明显好于肌肉移植组(3.8±-0.9和3.2±-0.8；P=0.035)。在接受肌肉移植的患者中，运动恢复与神经间隙的长度呈负相关(P=0.017)。变性肌肉移植可用于桥接短的桡神经缺损区，但修复质量明显不如神经移植修复。即使用变性肌肉移植物修复相对较短的神经缺损，其结果也与缝隙的长度成反比。
Background. The efficiency of denatured muscle grafting in nerve repair has been confirmed in experimental models and animals. The first clinical trials to repair digital nerves and mixed sensory-motor nerves were encouraging regarding sensory recovery but motor recovery was poor, probably because of delayed repair. We present the functional outcome of repair of motor nerves using denatured muscle graft and compare the results with those using standard nerve graft techniques.Methods. This prospective study included 9 radial nerve defects repaired with denatured muscle grafts and 23 radial nerve defects repaired using nerve grafts. Missile induced nerve injury, mid-arm level of lesion, a nerve gap smaller than 6 cm, and a preoperative interval of less than 5 months were characteristics shared by all patients. None of the patients had concomitant vascular injury, severe scarring, or significant soft tissue damage in the region of nerve repair. Motor recovery was estimated with 0-5 points, at least 4.7 years after surgery, according to the BMRC scale.Results. A successful outcome (>= M3) was achieved in 7 out of the 9 patients treated using a muscle graft and in 21 out of the 23 patients treated using nerve grafts (P > 0.05). Excellent recovery and the clinically significant re-establishment of thumb extension (M5 grade) were never achieved in the patients treated using muscle grafts. The average motor score was significantly better in patients treated with nerve grafts than in those who received muscle grafts (3.8 +/- 0.9 and 3.2 +/- 0.8; P = 0.035). With the patients who received muscle grafts, an inverse correlation existed between motor recovery and the length of the nerve gap (P = 0.017).Conclusions. Denatured muscle grafts can be useful for bridging short radial nerve defects, but the quality of recovery is significantly worse than after nerve graft repair. Even if relatively short nerve defects are bridged with denatured muscle grafts, the outcomes correlate inversely with the length of the gap.