中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (7): 1280-1288.doi: 10.4103/1673-5374.251338

• 原著:周围神经损伤修复保护与再生 • 上一篇    

神经应变重新分配实现张力下端对端修复损伤周围神经不会抑制神经再生

  

  • 出版日期:2019-07-15 发布日期:2019-07-15
  • 基金资助:

    美国退伍军人事务部资助

Redistribution of nerve strain enables end-to-end repair under tension without inhibiting nerve regeneration

Holly M. Howarth 1 , Turki Alaziz 2 , Brogan Nicolds 1 , Shawn O’Connor 3 , Sameer B. Shah 1, 2, 4   

  1. 1 Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
    2 Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
    3 School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
    4 Research Service, VA San Diego Healthcare System, San Diego, CA, USA
  • Online:2019-07-15 Published:2019-07-15
  • Contact: Sameer B. Shah, PhD, sbshah@ucsd.edu,
  • Supported by:

    This study was supported by the Department of Veterans Affairs (VA MERIT IRX001471A to SBS).

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摘要：

与神经移植修复相比，在无张力或低张力下的端对端修复更广泛用于短距离神经缺损。神经移植通常用于无张力修复中等到长距离周围神经缺损，因为过度的张力可导致修复失败。实验提出假设：重新分配修复部位张力方法可用于端对端修复较短距离神经缺损，且这种方法不会对结构和功能再生产生不利影响。实验通过或不通过从修复界面重新分配张力，端对端修复横断大鼠坐骨神经3mm较短距离神经缺损，发现该方法可以实现较长距离神经缺损的安全端到端修复。神经应变的重新分配对张力下修复不影响神经再生结构和功能，因而张力下端到端修复可用为较短距离神经缺损的合理手术策略。

orcid: 0000-0001-6613-3904 (Sameer B. Shah)

关键词: 张力, 应变, 生物力学, 端-端吻合, 周围神经, 外科修复, 神经再生

Abstract:

End-to-end repair under no or low tension leads to improved outcomes for transected nerves with short gaps, compared to repairs with a graft. However, grafts are typically used to enable a tension-free repair for moderate to large gaps, as excessive tension can cause repairs to fail and catastrophically impede recovery. In this study, we tested the hypothesis that unloading the repair interface by redistributing tension away from the site of repair is a safe and feasible strategy for end-to-end repair of larger nerve gaps. Further, we tested the hypothesis that such an approach does not adversely affect structural and functional regeneration. In this study, we used a rat sciatic nerve injury model to compare the integrity of repair and several regenerative outcomes following end-to-end repairs of nerve gaps of increasing size. In addition, we proposed the use of a novel implantable device to safely repair end-to-end repair of larger nerve gaps by redistributing tension away from the repair interface. Our data suggest that redistriubution of tension away from the site of repair enables safe end-to-end repair of larger gap sizes. In addition, structural and functional measures of regeneration were equal or enhanced in nerves repaired under tension – with or without a tension redistribution device – compared to tension-free repairs. Provided that repair integrity is maintained, end-to-end repairs under tension should be considered as a reasonable surgical strategy. All animal experiments were performed under the approval of the Institutional Animal Care and Use Committee of University of California, San Diego (Protocol S11274).

Key words: tension, biomechanics, strain, end-to-end repair, peripheral nerve, nerve regeneration