周围神经损伤的分类及潜在治疗方法

Classification and Potential Treatment of Peripheral Nerve Injury

周围神经损伤(PNI)是手外科常见疾病之一。一旦损伤后,即使在显微手术下进行外膜或束膜缝合,神经功能也不可能完全恢复正常。在我国,随着工业化程度加深和交通业的发展,周围神经损伤的发病率不断升高。对于较小的神经损伤,可通过手术直接缝合,而应用传统显微外科自体神经移植是治疗大段的周围神经缺损最有效的方法之一。然而这种方法存在一些局限性,如:供区的有限性、供体损伤及形态不一致、供区神经瘤形成及运动、感觉障碍等,极大地限制了它们在临床上的广泛应用。目前,周围神经损伤不仅仅局限于显微外科术的治疗,而涉及跨学科综合治疗。药理学、组织工程学、基因工程等都辅助参与周围神经损伤修复。该文简要地总结了周围神经的分类、病理生理及外伤性周围神经损伤修复潜在方法的优点与局限性。

Peripheral nerve injury is one of the common diseases in hand surgery and is a major social health problem.Once a nerve is damaged,it is unlikely that the nerve function will ever fully return to normal,even with episcleral or fascicular suturing under microsurgery.In China,the incidence of peripheral nerve injuries has risen with the deepening of industrialization and the development of the transportation industry.For smaller nerve injuries,direct surgical suturing can be performed.And the application of traditional microsurgical autologous nerve graft is one of the most effective methods for treating large segments of peripheral nerve defects.However,this method has some limitations,such as limited donor area,inconsistent donor injury and morphology,neuroma formation in the donor area,and motor and sensory impairment,which greatly limit their widespread application in clinical practice.Currently,peripheral nerve injury therapy is not only limited to microsurgical treatment,but also an integrated interdisciplinary treatment.Pharmacology,tissue engineering,and genetic engineering all assist in the repair of peripheral nerve injury.This article briefly summarizes the classification of peripheral nerves,their pathophysiology,as well as the advantages and limitations of potential approaches of traumatic peripheral nerve injury repairment.