THE SCIENCE OF NERVE REPAIR

描述（由申请人提供）：

DESCRIPTION (provided by applicant): Peripheral nerve injury is a significant clinical problem. Forty thousand nerve injuries occur in the US each year. However, treatment of these injuries has yet to benefit from recent dramatic advances in medical science. Sewing cut nerve ends together with needle and thread remains as the principle therapeutic option. This treatment will restore useful function to only 1/2 of adults with nerve injuries, and only 10% will approach normal function. Most will have permanent sensory and motor deficits, interfering with or preventing work or vocational activities. Available books on nerve repair focus on either clinical or scientific aspects of the problem, and little is done to integrate the two. Almost all are prepared by multiple authors. For the past 20 years I have specialized in the treatment of nerve injuries while simultaneously investigating these problems n the laboratory. My goal in writing The Science of Nerve Repair is to unite surgical and basic science approaches, and thus surgical and basic science communities, to devise better solutions to the problems of nerve injury. The book will begin by reviewing current clinical results to learn what they can teach us about the biology of human nerve regeneration. The relative disorganization of this material necessitated a statistically rigorous meta-analysis to more clearly define current clinical reality. Outcomes from treatment of individual nerves will be grouped and analyzed around biological themes instead of in the anatomical format familiar to surgeons. This review will also identify the areas where clinical need is most pressing, a necessary step towards defining priorities for future research. The main body of the text will critically evaluate the basic science relevant to the structure, function, and regeneration of the peripheral nervous system, emphasizing recent work on the molecular events of axonal growth and guidance. The third and final section will integrate the first two sections, the clinical and scientific past, to attempt a blueprint for the future. For instance, Chapter 1 establishes patient age as the primary determinant of outcome after nerve injury. Identification of regeneration components that deterioriate with age and their restoration to juvenile functional levels should therefore be a primary goal of future research. Publication by Oxford University Press will assure that this work reaches a wide audience, maximizing its ability to stimulate young investigators, both surgical and scientific, to form partnerships to solve the problems of nerve regeneration.