Early clinical experience with collagen nerve tubes in digital nerve repair
Early clinical experience with collagen nerve tubes in digital nerve repair
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DOI：
10.1016/j.jhsa.2008.03.015
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发表时间：
2008-09-01
影响因子：
1.9
通讯作者：
Messer, Terry M.
中科院分区：
文献类型：
--
作者：
Bushnell, Brandon D.;McWilliams, Andrew D.;Messer, Terry M.
目的在指神经损伤中，神经末梢不能在没有张力的情况下接近，自体神经移植是最常用的重建方法。最近，人们对合成神经导向器作为移植的替代方案的兴趣有所增加。尽管几项基础科学研究显示了胶原管的前景，但关于其在人类身上成功的临床研究有限。这项研究的目的是回顾我们早期使用胶原神经管的临床经验。方法作者确定并跟踪了我们机构2年来所有涉及指神经修复的病例。在研究期间，12名患者使用胶原神经管修复了指神经。两名患者失访，1名患者继发于其他损伤并发症而截断移植手指。其余9例患者的主要结果数据点是静态两点辨别力(2PD)、Semmes-Weinstein单丝测试和最终随访时的神经、肩和手快速残疾(DASH)结果调查。结果9例患者获得至少1年的随访，平均随访时间15个月(范围12-22个月)。术中和术后均未出现与神经管相关的并发症。根据改良的美国手部外科学会指南，9名患者中有8名患者的2PD结果为良或优。Semmes-Weinstein测试结果完整5例，光触觉减少2例，保护性感觉减弱1例，保护性感觉丧失1例。平均Quick Dash总分为10.86分，工作模块为4.86分，运动/表演艺术模块为23.21分。结论虽然本研究中的患者仍处于早期随访期，但我们的初步结果与现有文献报道的各种神经修复和重建的结果相比是有利的，提示胶原神经管可能为恢复感觉功能提供了一种临床有效的选择。
Purpose In cases of digital nerve injury in which nerve ends cannot be approximated without tension, autologous nerve grafts represent the most commonly used method for reconstruction. Recently, interest in synthetic nerve guides as an alternative to grafting has increased. Although several basic science studies have shown promise for collagen tubes, clinical studies of their success in humans are limited. The purpose of this study was to review our early clinical experience with collagen nerve tubes.Methods The authors identified and followed all cases involving digital nerve repair at our institution over a 2-year period. Twelve patients had repair of a digital nerve with a collagen nerve tube during the study period. Two patients were lost to follow-up, and I patient had amputation of the grafted finger secondary to complications of other injuries. The primary outcome data points for the remaining 9 patients were the static 2-point discrimination (2PD), Semmes-Weinstein monofilament testing, and a Quick Disabilities of the Ann, Shoulder, and Hand (DASH) outcome survey at final follow-up.Results Nine patients had follow-up of at least I year, with an average follow-up time of 15 months (range 12-22 months). There were no intraoperative or postoperative complications related to the nerve tubes. Using modified American Society for Surgery of the Hand guidelines, 2PD results were good or excellent in 8 out of 9 of patients. Semmes-Weinstein testing results were full in 5 patients, diminished light touch in 2, diminished protective sensation in 1, and loss of protective sensation in 1. Average Quick DASH scores for the group were 10.86 overall, 4.86 for the work module, and 23.21 for the sports/performing arts module.Conclusions Although the patients in this study are still within the early follow-up period, our initial results compare favorably with those reported in the existing literature for various types of nerve repair and reconstruction, suggesting that collagen nerve tubes might offer a clinically effective option for restoration of sensory function.