超过神经外膜深度：模拟周围神经撕裂的高分辨率显微计算机断层扫描表征周围神经损伤

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-09-18 DOI:10.1016/j.jhsg.2025.100833

Rasa Zhukauskas MD , Brandon S. Smetana MD , Adam B. Strohl MD , Sunishka M. Wimalawansa MD, MBA , Eitan Melamed MD , Amy M. Moore MD , Fraser J. Leversedge MD , Youssra Marjoua MD , Bauback Safa MD

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引用次数: 0

摘要

目的：急性创伤性撕裂伤引起的神经损伤很难评估，通常使用镜或手术显微镜进行评估。然而，临床上对损伤区域的界定仅限于评估神经外膜和/或横断的神经末梢的可见损伤，与神经损伤相对应的触觉变化在急性情况下并不明显。在外科神经修复或重建过程中，对受损组织进行充分的清创是必不可少的，因为神经束的健康影响神经的再生潜能。本研究使用一种新的高分辨率成像方法来表征三种常见机制造成的创伤性撕裂伤的神经损伤程度。方法采用12例人体上肢尸体标本，用刀、碎玻璃或台锯在屈肌腱II区或v区模拟常见损伤，由经验丰富的周围神经外科医生在放大镜下目测神经损伤与横断端的距离。神经损伤的长度用显微计算机断层摄影测量，然后与视觉估计的损伤进行比较。结果x线图像分析显示束状断裂从横断面向近端和远端延伸，刀伤平均低估了9.5 mm，碎玻璃伤平均低估了7.8 mm，表锯伤平均低估了12.1 mm。近端和远端神经、刀伤和碎玻璃伤的x线损伤程度相似，但台锯伤最广泛。结论表锯伤以神经损伤最严重。放射成像显示神经束损伤超出了外科医生对神经外损伤的视觉评估，表明外伤性撕裂伤对神经的内部损伤没有得到外科医生的重视。这种被低估的损伤对受损神经再生潜能的影响需要进一步研究。研究类型/证据水平

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More Than Epineurium Deep: Characterizing Peripheral Nerve Damage Using High-Resolution Micro-Computed Tomography for Simulated Peripheral Nerve Lacerations

Purpose

Nerve damage because of acute traumatic lacerations is challenging to assess and is typically evaluated using loupes or an operating microscope. However, defining the zone of injury clinically is limited to evaluating the epineurium and/or transected nerve ends for visible injury, with tactile changes corresponding with nerve damage not evident in the acute setting. During surgical nerve repair or reconstruction, adequate debridement of the damaged tissue is essential, as fascicular health influences the regenerative potential of the nerve. This study used a novel high-resolution imaging method to characterize the extent of nerve damage resulting from 3 common mechanisms of traumatic lacerations.

Methods

Twelve human upper extremity cadaveric specimens were used to simulate common injuries using a knife, broken glass, or table saw in flexor tendon zones II or V. The distance of nerve damage measured from the transected end was visually estimated by experienced peripheral nerve surgeons under loupe magnification. The length of nerve damage was measured radiographically using micro-computed tomography and then compared with visually estimated damage.

Results

Radiographic image analysis revealed fascicular disruption extending proximally and distally from the transection, which was underestimated by visual assessment 9.5 mm on average in knife injuries, 7.8 mm in broken glass injuries, and 12.1 mm in table saw injuries. The extent of radiographic damage was similar in proximal and distal nerves, and in knife and broken glass lacerations, but most extensive in table saw lacerations.

Conclusions

Nerve damage was greatest in table saw lacerations. Radiographic imaging showed fascicular damage extending beyond the surgeon’s visual assessment of epineural damage, indicating that the internal damage to nerves from traumatic lacerations was underappreciated by surgeons. The impact this underestimated damage has on regenerative potential of an injured nerve requires further investigation.