Development of new therapy for causalgie using in situ Tissue Engineering.

作为该项目的成果，我们已经将新理论应用于临床，并报道了两例慢性疼痛的临床病例。虽然因果痛通常是主要神经部分损伤的结果，最常见的是支配手部的正中神经，但也见于指神经损伤。术前症状稳定，经疼痛临床医生诊断为CRPS II型伴异常性痛、震颤、关节挛缩、血管舒张性异常。在手术中，观察到神经萌芽从受伤神经的近端和远端延伸到周围组织。在这两个病例中，萌芽也发生在受伤神经的远端，并扩散到观察到疼痛的区域。在这两个病例中，手术涉及将神经残端插入pga -胶原蛋白管，从而覆盖神经末梢。中空PGA可吸收神经管已在临床上应用。切除神经瘤和相关的神经芽，用PGA管覆盖神经末端可能会减轻疼痛。我们的两位患者在神经再生成功后，电生理评估显示功能恢复。因此，周围神经的恢复可能会影响中枢神经的功能，从而防止疼痛的再次发生。进一步的临床研究是必要的，以确定管是否也有效的其他临床症状，如镜区，幻肢痛。因此，这些病例的临床结果表明，使用神经引导管解决周围神经损伤伴随疼痛和功能丧失的新手术方法是可能的。

As the results of this project, we have already applied the new theory to clinics and reported two clinical cases of chronic pain. Though causalgia is often the result of partial injury to a major nerve, most commonly the median nerve supplying the hand, it is also seen following the digital nerve injury. The preoperative symptoms had become stable and they had been diagnosed by pain clinicians as having CRPS type II accompanied by allodynia, tremor, joint contracture, and vasomotor abnormality. At surgery, nerve sprouting was observed to extend from the proximal and distal sites of the injured nerve to the surrounding tissues. In these two cases, sprouting had also occurred in the distal part of the injured nerve and spread to the areas in which pain was observed. Surgery in the present two cases involved insertion of the nerve stumps into a PGA-collagen tube, thus covering the nerve ends. Hollow PGA resorbable nerve tubes have already been used clinically. Removing the neuroma with associated nerve sprouts and covering the nerve ends with a PGA tube might reduce the pain. Both of our present patients showed functional recovery, as indicated by electrophysiological evaluations, after successful nerve regeneration. Accordingly, peripheral nerve recovery may have an influence on central nerve function to prevent the recurrence of causalgia. Further clinical studies will be necessary to determine whether the tube is also effective for other clinical symptoms of causalgia, such as mirror region, phantom pain. Thus, the clinical outcomes in these cases indicate the possibility of a new surgical approach using a nerve guide tube for resolution of peripheral nerve injury accompanied by causalgia and functional loss.