Abstract:
Peripheral nerve injuries (PNI) are a major clinical problem. In general, PNI results from motor vehicle accidents, lacerations with sharp objects, penetrating trauma (gunshot wounds) and stretching or crushing trauma and fractures. They can result in significant morbidity, including motor and/or sensory loss, which can affect significantly the life of the patient. Currently, the standard surgical technique for complete nerve transection is end-to-end neurorrhaphy. Unfortunately, there is segmental loss of the nerve trunk in some cases where nerve mobilization may permit end-to-end neurorrhaphy if the gap is less than 1 cm. When the nerve gap exceeds 1 cm, autologous nerve grafting is the gold standard of treatment. But in light of limited availability and concerned donor site morbidity, other techniques have been used: vascularized nerve grafts, cellular and acellular allografts, nerve conduits, nerve transfers and end-to-side neurorrhaphy. This review intends to present an overview of the literature on the applications of these techniques in repair of peripheral nerve injuries. This article also focuses on preoperative assessment, surgical timing, available options and future perspectives.
摘要:
周围神经损伤(PNI)是一个主要的临床问题。总的来说,机动车事故的PNI结果,用尖锐的物体撕裂,穿透性创伤(枪伤)和拉伸或挤压创伤和骨折。它们可以导致显著的发病率,包括运动和/或感觉损失,会严重影响患者的生活。目前,完整神经横切术的标准外科技术是端到端神经吻合术.不幸的是,在某些情况下,如果间隙小于1cm,神经动员可能允许进行端到端神经吻合,则神经干存在节段性丢失。当神经间隙超过1厘米时,自体神经移植是治疗的金标准。但鉴于有限的可用性和相关的供体部位发病率,其他技术已经被使用:血管化神经移植,细胞和无细胞同种异体移植物,神经导管,神经转移和端侧神经吻合。这篇综述旨在概述有关这些技术在周围神经损伤修复中的应用的文献。本文还着重于术前评估,手术时机,可用的选择和未来的前景。