Clinical effect of small gap suture of epineurium combined with acellular matrix peripheral nerve repair membrane wrapping in repairing median nerve injury
Shen Meihua1, Yang Jiajie1, Shi Xiaojian1, Qin Chao1, Shi Kaibing1, Shen Lingjie1, Liu Hefei1, Jiang Qiting2
1Department of Hand and Foot Surgery, Haimen District People's Hospital, Nantong 226100, China; 2Nanjing Jiangbei Hospital Hand and Foot Microsurgery, Nanjing 210048, China
Abstract：Objective This study aimed to investigate the clinical effects of the small gap suturing of the nerve outer membrane combined with the wrapping of the acellular matrix peripheral to the membrane of the nerve undergoing repair on the repair of median nerve injury. Methods Randomized controlled study. From April 2021 to October 2022, 62 patients with open median nerve injury on the wrist and palmar side were included in this study. The patients included 42 males and 20 females aged 18-65 (47.6 ± 10.9) years old. They were divided into the experimental (30 cases) and control (32 cases) groups in accordance with the random number table method. In the experimental group, after the small gap of the nerve outer membrane was sutured, the membrane of the nerve undergoing repair was wrapped around the acellular matrix at the anastomotic site and fixed. In the control group, after the small gap of the nerve outer membrane was sutured, the anastomotic site was left open. Observation indicators were obtained through the (1) comparison of baseline data, such as gender, age, and cause of injury, between the two groups of patients; (2) comparison of perioperative complications, such as infection, healing, and rejection reactions, between the two groups of wounds; (3) evaluation comparison of the results of the SWM test and two-point discrimination (2PD) test and recovery of median nerve sensory function at 3 and 6 months after operation between the two groups; (4)comparison of the recovery of median nerve motor function in the two groups by using the trial standard for the evaluation of median nerve function of the Hand Surgery Society of the Chinese Medical Association at 3 and 6 months after surgery. (5) comparison of the median nerve motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) between the two groups at 3 and 6 months after surgery. Results (1) No significant differences in gender, age, cause of injury, and other general data were found between the two groups (all P values > 0.05). (2) The operation was successfully performed for all patients in the two groups; the wrist wounds in the two groups were not infected; the wounds healed well 2 weeks after ; and no complications, such as inflammation and infection, were observed. (3) SWM and 2PD at 3 months after operation did not significantly differ between the experimental and control groups (all P values >0.05). SWM and 2PD at 6 months after operation in the experimental group were significantly better than those in the control group(Z =-2.64, -2.43; all P values <0.05). Intragroup comparison revealed that SWM and 2PD at 6 months after surgery were significantly better than those at 3 months after surgery (ZSWM=-4.36, -3.46,Z2PD =-3.60, -2.65; all P values < 0.05). The median nerve sensory function was 93.33% (28/30) in the experimental group and 68.75% (22/32) in the control group, and the difference between the two groups was statistically significant (χ2 =5.96,P =0.014). (4) Median nerve motor function at 3 months after operation did not significantly differ between the two groups (P >0.05). At 6 months after operation, median nerve motor function in the experimental group was significantly better than that in the control group (t =2.63, P =0.011). Intragroup comparison revealed that median nerve motor function at 6 months after surgery was significantly better than that at 3 months after surgery (t =15.75, 13.85, all P values <0.001). Median nerve motor function at 6 months after operation, the excellent and good rate of the experimental group was 90.00% (27/30) and that of the control group was 65.63% (21/32). The difference between the two groups was statistically significant (χ2 =5.26,P =0.022).(5)MNCV and SNCV at 3 months after operation did not significantly differ between the experimental and control groups (all P values >0.05). At 6 months after operation, the MNCV and SNCV of the experimental group were significantly better than those of the control group (t =3.42, 5.13; all P values <0.001). Intragroup comparison demonstrated that MNCV and SNCV at 6 months after surgery were significantly better than those at 3 months after surgery (tMNCV =15.01, 11.67, tSNCV =17.41, 15.57; all P values <0.001). Conclusion For the patients with open median nerve injury on the wrist, through the suturing of small gaps in the outer membrane of the nerve, the anastomotic site wraps around the acellular matrix surrounding the membrane of the nerve undergoing repair. This situation accelerates the recovery of sensory, motor, and coordination functions after median nerve injury. The main mechanism of this effect is attributed to the reduction in scar formation around the nerve, provision of nutritional factors for nerve regeneration, and promotion of nerve regeneration.Clinical trial registration: China Clinical Trial Center (ChiCTR210053188)
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Shen Meihua, Yang Jiajie, Shi Xiaojian, Qin Chao, Shi Kaibing, Shen Lingjie, Liu Hefei, Jiang Qiting. Clinical effect of small gap suture of epineurium combined with acellular matrix peripheral nerve repair membrane wrapping in repairing median nerve injury. Chinese Journal of Anatomy and Clinics, 2024, 29(4): 262-268.
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2024, Vol. 29 
