合成材料神经导管与自体神经移植修复周围神经缺损的比较

Synthetic nerve conduit versus autogenous nerve transplantation for repair of peripheral nerve defects

背景:生物可降解材料制成的神经导管可在体内降解,避免出现的神经卡压等问题,因而受到越来越多的关注。目的:比较自体神经移植与3种合成可生物降解材料神经导管在修复周围神经损伤的效果差异。方法:通过电生理学检测,形态学观察等神经恢复效果评价方法,对比分析近年来常用的胶原神经导管、DL-乳酸-ε-己内酯神经导管、聚乙醇酸神经导管与自体神经移植修复周围神经缺损的效果。结果与结论:虽然神经导管与自体神经移植相比在理论上有其优势的一面,但不同合成材料的神经导管之间在神经功能恢复中存在明显差异性,DL-乳酸-ε-己内酯神经导管修复效果与自体神经移植无明显差异,是较为理想的神经导管材料,聚乙醇酸神经导管因自身的因素影响其降解性能,在3种神经导管中的修复周围神经损伤效果最差,胶原神经导管需要交联剂改善其机械性能,其修复周围神经损伤效果居于前两者之间,因此,这3种神经导管在神经功能再生方面还有潜在的缺陷,不能完全替代自体神经移植,而且3者之间的性价比,还缺少足够的大样本长期随机对照实验结果来验证,还需要进一步的实验观察。

BACKGROUND：As the biodegradable materials produced nerve conduit can be degraded in vivo and can avoid the nerve entrapment, it has attracted more and more attentions. OBJECTIVE：To compare the effect of autogenous nerve transplantation and three kinds of synthetic biodegradable materials produced nerve conduit for the repair of peripheral nerve defects. METHODS：The effect of commonly used col agen nerve conduit, DL-lactic acid-ε-caprolactone nerve conduit, polyglycolic acid nerve conduit and autogenous nerve transplantation in the repair of peripheral nerve defects was evaluated with electrophysiological detection and morphological observation. RESULTS AND CONCLUSION：Theoretical y, the nerve conduit has some advantages when compared with autogenous nerve transplantation, but there was significant difference in neural functional recovery between different synthetic materials produced nerve conduits. The repair effect of DL-lactic acid-ε-caprolactone nerve conduit was similar to that of autogenous nerve transplantation, and was considered as the ideal nerve conduit material;due to the disadvantages of polyglycolic acid nerve conduit which can inhibit its degradation, polyglycolic acid nerve conduit showed least effect in repairing peripheral nerve defects among three kinds of nerve conduits;col agen nerve conduit could improve the mechanical properties with the help of crosslinker, so the effect in repairing peripheral nerve defects was lower than DL-lactic acid-ε-caprolactone nerve conduit and higher than polyglycolic acid nerve conduit. These three kinds of nerve conduits have their potential shortcomings in nerve function regeneration, so that can not completely replace autogenous nerve transplantation. There stil lacks of large sample long-term randomized control ed experiments to identify the performance price ratio between three kinds of nerve conduits. Further experimental observations are needed.