Tissue Engineering peripherer Nerven

Zusammenfassung

Hintergrund: Die Versorgung langstreckiger Nervenverletzungen stellt auch nach weiteren Fortschritten in der Mikrochirurgie eine große Herausforderung an den Chirurgen dar. Die autologe Nerventransplantation war hierfür in den vergangenen Jahren die einzige sinnvolle Behandlungsmöglichkeit. Aufgrund der bekannten Begleiterscheinungen dieses Verfahrens (mögliche Neurombildung, Sensibilitätsverlust im Areal des Spendernervs, limitierte Verfügbarkeit von Spendernerven etc.) sowie weiterhin eingeschränkter Regenerationsergebnisse wird immer häufiger die Anwendung verschiedener Tubulisationsverfahren zur Versorgung dieser Defekte propagiert. Ziel: Im Rahmen dieser Arbeit stellen wir zusammenfassend unsere Erfahrungen und Ergebnisse mit verschiedenen synthetisch hergestellten Materialien, zellulär besiedelten Nervenleitschienen und Venen zur Rekonstruktion peripherer Nerven vor. Material und Methoden: Zur Untersuchung des Regenerationspotenzials dieser Nervenleitschienen wurde ein Modell am N. medianus von Ratten verwendet. Die Defektstrecken betrugen bei diesen Versuchen bis zu 40 mm. Es wurden leere Hohlfasern aus verschiedenen Materialien eingesetzt (Trimethylencarbonat-ε-Caprolacton, Polyethylen, Venen, Kollagen) sowie Versuche mit zellbesiedelten Tubes (Schwann-Zellen) unternommen. Der längste Beobachtungszeitraum betrug hierbei neun Monate. Ergebnisse: In unseren Untersuchungen konnten wir nachweisen, dass lediglich Schwann-Zell-befüllte Hohlfasern eine Regeneration ermöglichen, die vergleichbar ist mit der eines autologen Nerventransplantats. Weiterhin zeigte sich, dass diese Regeneration im Verlauf von neun Monaten nur über eine Defektstrecke von 20 mm möglich war. Unter Verwendung längerer Defektstrecken war das autologe Nerventransplantat stets den Nervenleitschienen überlegen.

Abstract

Background: In spite of considerable progress in microsurgical techniques, the treatment of long distance defects in peripheral nerves remains challenging for the surgeon. Autologous nerve grafting has been the only applicable procedure to overcome such defects in the past. Due to the known disadvantages of this procedure (neuroma formation and sensory deficits at the donor-site, limited availability of donor-material, etc.) and impaired regenerative results, different tubulisation techniques are discussed more frequently as alternatives to the autologous nerve grafts. Aim of the Study: In this work, the authors summarise their experiences and results with different synthetically developed materials, cellular and acellular tubes and venous conduits for the reconstruction of peripheral nerve defects. Material and Methods: To analyse peripheral nerve regeneration, we utilised a median nerve model in rats. In these studies nerve gaps up to 40 mm were induced. Guiding tubes of various materials (trimethylene carbonate-ε-caprolactone, polyethylene, veins, and collagen) were employed. Furthermore, we introduced Schwann cells as cellular elements into some of the trimethylene carbonate-ε-caprolactone tubes. The longest postoperative observation period was nine months. Results: The results demonstrated that only in the case of cellular filled tubes (syngenic Schwann cells) did regeneration occur across the 20 mm gap. This regeneration was comparable to that induced after autologous grafting. Across a 40 mm gap the autologous graft demonstrated the best results.

Schlüsselwörter

Autologe Nerventransplantation - Nervenleitschienen - Schwann-Zellen - Nervenregeneration

Key words

Autologous nerve graft - nerve conduits - Schwann cells - nerve regeneration

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