背景:手指神经损伤与手部创伤很常见,经常需要手术。这些损伤的外科治疗可以使用几种技术进行:直接修复(神经吻合),自体移植,同种异体移植,和管道修复。鉴于增加各种数字神经修复技术的可用性和使用,我们进行了一项新的系统综述和荟萃分析,目的是对现有证据进行比较回顾,以确定结局的差异,从而更好地指导有指神经间隙病例的治疗.方法:使用静态2点判别(S2PD)对各种数字神经修复技术的感觉结果进行综述,移动两点判别(M2PD),Semmes-Weinstein单丝测试(SWMF),和并发症发生率作为感兴趣的结果。在应用纳入和排除标准后,回顾了15篇文章,分析了625例神经修复。结果:同种异体移植修复的平均间隙长度,自体移植修复,导管修复为15.4、24.7和13.4毫米,分别。对于S2PD结果,自体移植修复在统计学上优于所有其他形式的修复。同种异体移植的趋势高于神经吻合和导管修复,但结果无统计学意义。对于SWMF结果,自体移植修复在统计学上优于导管修复和神经修复术;它与同种异体移植修复具有统计学可比性。相对于M2PD,同种异体移植在统计学上优于导管修复。结论:基于当前更新的荟萃分析,使用更新的数据和技术,我们发现所有可用的技术都有合理的结果.然而,当处理有间隙的数字神经损伤时,从而排除了直接的神经吻合,自体移植和同种异体移植的效果相当,优于导管修复。
Background: Injuries to digital nerves are common with trauma to the hand, often requiring surgery. Surgical management of these injuries can be performed using several techniques: direct repair (neurorrhaphy), autograft, allograft, and conduit repair. In light of increasing the availability and use of various digital nerve repair techniques, a new systematic
review and meta-analysis was undertaken to comparatively
review the available evidence to determine any differences in outcomes to better guide treatment in cases with digital nerve gaps. Methods: Current literature on sensory outcomes of various digital nerve repair techniques was reviewed using static 2-point discrimination (S2PD), moving 2-point discrimination (M2PD), Semmes-Weinstein monofilament testing (SWMF), and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: The average gap length for allograft repair, autograft repair, and conduit repair was 15.4, 24.7, and 13.4 mm, respectively. For S2PD outcomes, autograft repair was statistically superior to all other forms of repair. Allograft trended higher than neurorrhaphy and conduit repair, but results were not statistically significant. For SWMF outcomes, autograft repair was statistically superior to conduit repair and neurorrhaphy; it was statistically comparable with allograft repair. Allograft performed statistically superior to conduit repair relative to M2PD. Conclusions: Based on the current updated meta-analysis using newer data and techniques, we found that all available techniques have reasonable outcomes. Yet when managing a digital nerve injury with a gap, thereby excluding direct neurorrhaphy, both autograft and allograft performed comparably and were superior to conduit repair.