周围神经再生桥接物在周围神经缺损修复中的作用

目的神经移植可以通过不同桥接物来完成,各种周围神经再生桥接物在周围神经缺损修复中有着重要的作用.方法应用计算机检索Medline数据库和万方数据库1996/2002期间有关周围神经再生桥接物研究的相关文献,包括神经纤维组织桥接物、非神经纤维组织桥接物、人工合成材料等内容.结果对周围神经再生桥接物的研究目前仍以3大类为主①神经纤维组织桥接物主要有自体神经、异体神经和异种神经.自体神经移植仍是目前治疗周围神经缺损的首选方法,然而对于粗大的、长段的外周神经移植物很难找到,且有供区神经瘤形成和运动、感觉障碍等并发症,造成新的神经损伤.异体和异种神经移植体,来源较自体广泛,不给患者带来新损伤,各种类型的神经段均可得到等优点,但存在宿主对移植体的免疫排斥反应问题.②非神经纤维组织桥接物自体非神经纤维组织桥接物来源广泛,其中静脉和肌肉研究较多.静脉桥接体桥接周围神经效果不及自体神经移植而优于肌肉、肌腱及硅橡胶,但由于缺乏促神经再生的活性因子,桥接较长的缺损时易于塌陷.③人工合成材料桥接物人工合成材料具有生理性好,无抗原性,无致癌性,植入体内异物反应小,桥接神经纤维的管腔不易塌陷,使神经近端再生的轴索可顺利的通过,减少瘢痕干扰,跨越缺损长入远端实现自然修复等优点成为近年来的研究热点.结论各种研究仍停留于动物实验阶段,目前临床治疗周围神经缺损仍以自体神经移植为主,临床新的治疗方法还有待学者再进行深入研究.

Effect of peripheral nerve regenerated grafts in repair of peripheral nerve gaps

AIM: Nerve transplantation can be accomplished by various grafts. The regenerated grafts of various kinds of peripheral nerve plays an important role in repair of peripheral nerve gaps.METHODS: The relevant literatures on researches on regenerated grafts of peripheral nerve were collected by retrieval system of Medline database and Wanfang database from 1996 to 2002, including grafts of nerve fiber tissue,non-nerve fiber tissue and artificial synthetic material.RESULTS: There are 3 categories mainly involved in the researches on regenerated grafts of peripheral nerve at present. ① Graft of nerve fiber tissue:It includes autologous nerve, allogeneic nerve and heterogenous nerve. Nerve autograft is still the first choice definitely in treatment of peripheral nerve gaps. But it is difficult to find out the grafts of thick and large peripheral nerve and the complications often present, such as neuroma in providing area and motor-sensory disturbance, resulting in new nerve injury. Grafts of allogeneic and heterogenous nerve are more extensive in sources compared with autologous one, without new injury resulted. And they are applicable from various nerve segments. But the immuno-rejection is existed between host and the grafts. ② Graft on non-nerve fiber tissue: The autograft of non-nerve fiber tissue is provided extensively, for which, more researches are focused on veins and muscles. The effect on peripheral nerve bridged by venous graft is inferior to that by nerve autograft, but superior to that by muscles, tendon and silicon latex. But, due to lack of active factor for nerve regeneration, collapse is easily resulted in bridging chronic gaps. ③ Graft of artificial synthetic material: Artificial synthetic material has satisfactory physiology, is absence of antigen and avoids carcinoma. The foreign body rejection is less after implantation, the collapse dose not happen easily in the bridged lumen of nerve fiber, for which, axon regenerated in proximal nerve can pass through successfully, scar intervention is decreased and the natural repair is achieved by generating into the distal through gaps. For above-mentioned advantages, artificial synthetic material becomes the hot topic in researches of recent years.CONCLUSION: The researches of various kinds are still maintained at the stage of animal experiment. Nerve autograft is still predominated in clinical treatment of peripheral nerve gaps at present. It is expected to carry on further researches on new approaches in clinical treatment.