Translated Abstract
AbstractResearch background and objective: Despite the microsurgery technical improvements in peripheral nerve surgery, reconstruction of the transected nerves has been achieved a rigorous level, but the classic methods of nerve repairing have failed to provide satisfactory results. One of the most important reasons is that the traumatic scarring interfere its regeneration and functional recovery. In one hand, scarring of the nerve produces tethering and/or compression of nerve roots, which can lead to a spectrum of changes ranging from ischemia to irreversible nerve injury, such as fibrous degeneration. On the other hand, epineurial scarring in peripheral nerve after injury results in conduction block and establishes a mechanical barrier to axonal regeneration. The regeneration process is often blocked by scar formation and misdirection of axon sprouts. What is more, even if the transected peripheral nerve can obtain ideal reconstraction to get to its effector, the scarring of the nerve will hindrance the electroneurographic signal, and severely inhibit its function. Therefore, traumatic scarring in peripheral nerve will result in severely influence during the different stage of the regeneration process.In recent years, a great achievement has been obtained in prophylactic treatment of scarring, especially the concept of scarrless healing and its implement in some adult organs. This concept for therapeutic collagen reduction is so attractively that surgeons were aroused to apply this ideal prosthetic pattern to the peripheral nerve surgery. This study was aimed to imitate the scarless healing in fetus, prophylactic treatment were used in order to minimizing the traumatic scar formation and improving the curative effect of the injuried peripheral nerve.Content and result: 1. The clinical date and post-operation specimen of 58 patients with traumatic scarring due to different kind of reasons were obtained from July 1995 to October 2003, to summarize the influence effect of scarring to the nerves’ functional and the pathologic characters. The traumatic neuroma, which were composed with the deposited collagen fibers were observed in pathologically, and its barrier function to the regeneration of the peripheral nerves resulting in chronic pain syndrome with diminished sensation, muscular dystrophy.2. To investigate the prevention effect of topical applications of hyaluronic acid or anti-TGF-β1 on injured peripheral nerve scarring and regeneration in an adult rat model. All animals were demonstrated complete skin and muscle fascia closure. In the nerve adherence category, significantly lower scores were found in nerves treated with HA or anti-TGF-β1 in comparison with control group after surgery. Nerves treated with HA or anti-TGF-β1 demonstrated significant reduction in perineural scar thickness by Masson’s trichrome for collagen and immunohisto- chemistry of Collagen Type Ⅰand Ⅲ. Ultrastructural organization was observed for evaluation of scarring formation. The results showed that the nerve fiber was line up in order in experimental group, and collagen fiber disordered in control group. At the same time， the results of SFI and the neural electrophysiologic study after twelve weeks show that the neural regeneration situation of the experimental group was superior to the control group. And so were the results of nerve fiber specific staining and myelin staining.3. At the basic of above-mentioned research, we observed the harmful effects to the spinal cord while the prophylactic treatment of scarring were used in the local state. The result shows that GAP-43 expression, the motor neurons number and the ChE activity in the injuried side of spinal cord were no significant difference between experimental group and control group.Conclusions:1. In the clinical research of peripheral nerve surgery, the local traumatic scarring or traumatic neuroma composed with the deposited collagen fibers will be harmful to the transmission function and control function, result in the functional impairment to some degree. 2. Hyaluronic acid appears to be effective in preventing perineural scar formation, resulting in enhancement of peripheral nerve regeneration in transected peripheral nerve.3. Antibody to transforming growth factor beta can reduces collagen production and improves the function recovery after peripheral nerve injures.4. After the peripheral nerve repaired, the normal transmission function, control function and regeneration function of the spinal cord will not be influenced while the prophylactic treatment of scarring were used in the local state.
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