Periphere Nervenverletzungen

Zusammenfassung

Jährlich werden in Deutschland mehr als 100 000 Patienten mit Verletzungen des peripheren Nervensystems operativ versorgt. Folgen einer unzureichenden Regeneration der betroffenen Nerven sind ein Kontaktverlust der Nervenstümpfe und das unterrichtete Aussprossen der Axone. Durch eine unvollständige Regeneration erleiden die Patienten nicht selten eine signifikante Einschränkung ihrer Lebensqualität. Da sich der Regenerationsprozess grundlegend von dem anderer Gewebe unterscheidet, sind genaue Kenntnisse der Anatomie und der Physiologie des Nerven notwendig. Soweit möglich sollte eine primäre, epineurale Koaptation erfolgen. In der vorliegenden Übersicht möchten wir aktuelle chirurgische Versorgungstechniken mit deren Indikationen darstellen sowie einen Ausblick auf mögliche zukünftige Therapieansätze geben.

• Literatur

• 1 Kouyoumdjian JA. Peripheral nerve injuries: a retrospective survey of 456 cases. Muscle Nerve 2006; 34: 785-788
• 2 Siemionow M, Brzezicki G. Chapter 8: Current techniques and concepts in peripheral nerve repair. Int Rev Neurobiol 2009; 87: 141-172
• 3 Burnett MG, Zager EL. Pathophysiology of peripheral nerve injury: a brief review. Neurosurg Focus 2004; 16: E1
• 4 Aegineta P. De re medica. Paulou Aiginetou iatrou aristoubiblia hepta. En arche hekastou ton biblion deiknytai ta en ekeino pereichomena. Pavli Aeginetae medici optimi. Libri septem. 1528
• 5 Waller A. Experiments on the section of the glossopharyngeal and hypoglossal nerves of the frog, and observations of the alterations produced thereby in the structure of their primitive fibres. Philosophical Transactions of the Royal Society of London 1850. 140: 423-429
• 6 Millesi H. Microsurgery of peripheral nerves. Hand 1973; 5: 157-160
• 7 Sunderland S. Nerve Injuries and their Repair: A critical Appraisal. London: Churchill Livingstone; 1991
• 8 Kurze T. Microtechniques in neurological surgery. Clin Neurosurg 1964; 11: 128-137
• 9 Smith JW. Microsurgery of peripheral nerves. Plast Reconstr Surg 1964; 33: 317-329
• 10 Grinsell D, Keating CP. Peripheral Nerve Reconstruction after Injury: A Review of clinical and experimental Therapies. Biomed Res Int 2014; 698256
• 11 Sunderland S. The intraneural topography of the radial, median and ulnar nerves. Brain 1945; 68: 243-298
• 12 Bittner GD, Schallert T, Peduzzi JD. Degeneration, trophic interactions, and repair of severed axons: a reconsideration of some common assumptions. Neuroscientist 2000; 6: 88-109
• 13 Griffin JW, Hogan MV, Chhabra AB et al. Peripheral nerve repair and reconstruction. J Bone Joint Surg A 2013; 95: 2144-2151
• 14 Pfister BJ, Gordon T, Loverde JR et al. Biomedical engineering strategies for peripheral nerve repair: surgical applications, state of the art, and future challenges. Crit Rev Biomed Eng 2011; 81-124
• 15 Lee SK, Wolfe SW. Peripheral nerve injury and repair. J Am Acad Orthop Surg 2000; 8: 243-252
• 16 Seedon HJ. Peripheral nerve injuries. Medical Research Council. Special Report Series 282. London: Her Majesty’s Stationery Office; 1954
• 17 Sunderland S. Rate of regeneration of sensory nerve fibers. Arch Neurol Psychiatry 1947; 58: 1-6
• 18 Mackinnon SE, Dellon AL. Nerve Repair and Nerve Grafts. In: Mackinnon SE, ed. Surgery of the Peripheral Nerve. Stuttgart: Thieme; 1988
• 19 Wolfe SW, Hotchkiss RN, Pederson WC et al. Greenʼs Operative Hand Surgery. Vol. 1. 6. th ed. London: Churchill Livingstone; 2010: 1035-1092
• 20 Griffin JW, Hogan MV, Chhabra AB et al. Peripheral nerve repair and reconstruction. J Bone Joint Surg A 2013; 95: 2144-2151
• 21 Pfister BJ, Gordon T, Loverde JR et al. Biomedical engineering strategies for peripheral nerve repair: surgical applications, state of the art, and future challenges. Crit Rev Biomed Eng 2011; 39: 81-124
• 22 Kline DG. Physiological and clinical factors contributing to the timing of nerve repair. Clin Neurosurg 1977; 24: 425-455
• 23 Lundborg G. A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance. J Hand Surg 2000; 25: 391-414
• 24 Colen KL, Choi M, Chiu DTW. Nerve grafts and conduits. Plast Reconstr Surg 2009; 124 (Suppl): e386-e394
• 25 Taylor GI, Ham FJ. The free vascularized nerve graft. A further experimental and clinical application of microvascular techniques. Plast Reconstr Surg 1976; 57: 413-425
• 26 Battiston B, Tos P, Conforti LG et al. Alternative techniques for peripheral nerve repair: conduits and end-to-side neurorrhaphy. Acta Neurochir Suppl 2007; 100: 43-50
• 27 Bain JR, Mackinnon SE, Hudson AR et al. The peripheral nerve allograft in the primate immunosuppressed with Cyclosporin A: I. Histologic and electrophysiologic assessment. Plast Reconstr Surg 1992; 90: 1036-1046
• 28 Lin YC, Marra KG. Injectable systems and implantable conduits for peripheral nerve repair. Biomed Mater 2012; 7 024102
• 29 Dvali LT, Myckatyn TM. End-to-side nerve repair: review of the literature and clinical indications. Hand Clin 2008; 24: 455-460
• 30 Lee SK, Wolfe SW. Nerve transfers for the upper extremity: new horizons in nerve reconstruction. J Am Acad Orthop Surg 2012; 20: 506-517
• 31 Myckatyn TM, Mackinnon SE. Microsurgical Repair of peripheral Nerves and Nerve Grafts. In: Thorne CH, Bartlett SP, Beasley RW, et al., eds. Grabb & Smith’s Plastic Surgery. Philadelphia: Lippincott Williams & Wilkins; 2006
• 32 Tung TH, Mackinnon SE. Nerve transfers: indications, techniques and outcomes. J Hand Surg Am 2010; 35A: 332-341
• 33 Brunelli G. Direct Neurotisation of severely damaged and denervated Muscles. In: Freilinger G, Olle J, Carlson BM, eds. Muscle transplantation. Berlin: Springer; 1981: 283-286
• 34 Carlsen BT, Bishop AT, Shin AY. Late reconstruction for brachial plexus injury. Neurosurg Clin N Am 2009; 20: 51-64
• 35 Rosen B, Lundborg G. Sensory Re-education following Nerve Repair. In: Slutsky D, ed. Upper Extremity Nerve Repair – Tips and Techniques: A Master Skills Publication. Chicago: ASSH; 2008: 159-178
• 36 Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve 1990; 13: 771-784