Early clinical outcomes with the use of decellularized nerve allograft for repair of sensory defects within the hand.
Early clinical outcomes with the use of decellularized nerve allograft for repair of sensory defects within the hand.
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DOI：
10.1007/s11552-009-9195-6
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发表时间：
2009-09-01
期刊：
影响因子：
--
通讯作者：
Moran, Steven L
中科院分区：
文献类型：
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作者：
Karabekmez, Furkan E;Duymaz, Ahmet;Moran, Steven L
神经导管已成为修复高达2 cm的感觉缺损的既定选择。最近，脱细胞神经同种异体移植物也被提倡作为神经修复的一种选择;然而，没有临床研究检查其治疗感觉神经缺损的有效性。本研究的目的是检查我们早期使用脱细胞神经同种异体移植修复手部和手指节段性神经缺损的经验。从2007年7月至2008年3月，7例患者有10个神经间隙，手术治疗脱细胞神经同种异体移植物。修复了8条指神经和2条背侧感觉神经。神经缺损的原因为外伤性神经切断8例，神经瘤切除重建2例。受累神经均为纯感觉纤维。由盲手治疗师使用移动和静态两点辨别测试来评估功能恢复。还评价了植入部位的任何感染、排斥或移植物挤出体征。有5名男性和2名女性，平均年龄为44岁（范围23-65）。神经移植长度0.5 ~ 3cm，平均2.23cm。平均随访时间为9个月（范围5-12）。在最后记录的随访中，平均两点辨别力为4.4 mm移动和5.5 mm静态。在移植材料周围没有观察到伤口感染，尽管进行了短期随访，但在所有患者中观察到感觉改善。两个手指需要再次探查，一个手指的屈肌腱断裂，另一个手指的屈肌腱松解。在这两种情况下，神经同种异体移植物是可视化的，似乎很好地融入修复部位。脱细胞同种异体神经移植能够在0.5至3 cm的神经缺损中恢复足够的感觉。无感染或排斥反应。脱细胞神经同种异体移植物可为超过2cm的节段性神经缺损提供一种选择。需要进行随机比较研究，以确定与胶原导管或自体神经移植物相比的疗效。
Nerve conduits have become an established option for repair of sensory deficits of up to 2 cm. More recently, decellularized nerve allograft has also been advocated as an option for nerve repair; however, no clinical studies have examined its efficacy for the treatment of sensory nerve defects. The aim of this study was to examine our early experience with the use of decellularized nerve allograft for repair of segmental nerve defects within the hand and fingers. From July 2007 to March 2008, seven patients who had ten nerve gaps were treated surgically using decellularized nerve allograft. Eight digital and two dorsal sensory nerves were repaired. The etiologies of the nerve defects were traumatic nerve transection in eight defects and neuroma resection and reconstruction in two defects. All of the affected nerves were pure sensory fibers. Functional recovery was evaluated by blinded hand therapist using moving and static two point discrimination tests. Implantation sites were also evaluated for any signs of infection, rejection, or graft extrusion. There were five men and two women with a mean age of 44 years (range 23-65). Mean nerve graft length was 2.23 cm with a range of 0.5-3 cm. Mean follow up time was 9 months (range 5-12). Average two point discrimination was 4.4 mm moving and 5.5 mm static at last recorded follow-up. There were no wound infections observed around the graft material and sensory improvement was observed in all of the patients despite this short-term follow-up. Re-exploration of two fingers was required for flexor tendon rupture in one and flexor tendon tenolysis in the other. In both cases, the nerve allograft was visualized and appeared well incorporated in the repair site. Decellularized nerve allografts were capable of returning adequate sensation in nerve defects ranging from 0.5 to 3 cm. There were no cases of infection or rejection. Decellularized nerve allograft may provide an option for segmental nerve gaps beyond 2 cm. Randomized comparative studies will be required to determine efficacy in comparison to collagen conduits or nerve autograft.