周围神经端侧缝合修复神经缺损的研究与应用

背景：神经端侧缝合对治疗神经近端回缩或撕脱消失的神经损伤有明显的优点，无需考虑受损神经近端缺损距离的大小，不影响供体神经的功能。 目的：总结端侧缝合修复周围神经的科研与临床领域方面的研究，为修复周围神经缺损，特别是神经缺损较长、近端无法寻找而不能做端端缝合时，提供一种可供选择的途径。 方法：由第一作者应用计算机检索PubMed和万方数据库1990-01/2010-10发表的相关文献。以“end-to-side neurorrhaphy or end-to-side coaptation , nerve repair”或“神经端侧缝合或神经端侧缝合，神经修复”为检索词进行检索。选择与神经端侧缝合修复周围神经损伤有关的文献，同一领域文献则选择近期发表及发表在权威杂志的文章。 结果与结论：共检索到86篇文献，排除无关重复的文献，保留38篇文献进行综述。目前认为是许旺细胞可诱导完整的供体神经轴突的侧突出芽，许旺细胞在吻合口处快速增生，并产生大量营养因子。神经外膜及束膜，在神经端侧缝合中起到屏障作用，可阻止新生的轴突长入神经断端。端侧缝合对损伤的周围神经为有效的修复方式，必要时可在临床上广泛应用。

Research and application of end-to-side neurorrhaphy of peripheral nerve in repair of neurological defect

BACKGROUND:End-to-side neurorrhaphy has significant advantages for treating nerve injuries such as nerve proximal end atrophy or avulsion disappearance. No matter the distance of proximal end of defected nerve, end-to-side neurorrhaphy does not affect the function of donor nerve. OBJECTIVE:To summarize the scientific research and clinical studies concerning end-to-side anastomosis in repair of peripheral nerve, and to provide a pathway for repairing defects of peripheral nerve, especially that cannot do end-to-end anastomosis, because of long defects and unable to find at the proximal end. METHODS:The first author retrieved PubMed and Wanfang Database for relevant articles published from January 1990 to October 2010. The key words were “end-to-side neurorrhaphy, end-to-side anastomosis, nerve repair”. Articles on end-to-side anastomosis for repairing damage to peripheral nerve were selected, and those in the same field published recently or in authorized journals were included. RESULTS AND CONCLUSION:Totally 86 articles were retrieved. After excluding repetitive articles, 38 articles were used. Present studies have shown that Schwann cells can induce collateral process pullulation of complete donor neural axis. Schwann cells rapidly proliferated at stoma, and produced a large number of nutrition factor. Epineurium played a barrier function in end-to-side neurorrhaphy and prevented the entry of new axons into the broken end of nerve. End-to-side anastomosis is an effective repair method for damaged peripheral nerve, and can be used in clinic if necessary.