Abstract
This study aimed to observe the morphological characteristics of a PGLA [poly(glycolide-co-L-lactide)] nerve conduit and regenerated nerve bundle in the human body using high-frequency ultrasound and examine functional recovery of the regenerated nerve using functional magnetic resonance imaging (fMRI) after neural prosthesis with a PGLA nerve conduit. Thirty-nine patients underwent high-frequency ultrasound, and one patient with superficial radial nerve injury (27-mm defect) underwent fMRI at one, three, and six postoperative months. The fMRI examination results were compared with sensory detection and high-frequency ultrasound results during the same follow-up window period. The normal and regenerated nerve bundles had similar ultrasonic imaging features. At one postoperative month, fMRI displayed activeness of the normal cortex in the brain region corresponding to the contralateral superficial radial nerve, while no activeness was observed on the ipsilateral side. From three to six postoperative months, fMRI revealed gradually increasing activeness in the brain region corresponding to the ipsilateral superficial radial nerve, but the activation area on the ipsilateral side was smaller than that on the contralateral side. Combining morphological detection of the regenerated nerve using high-frequency ultrasound and functional detection of the regenerated nerve using fMRI may be a valuable method for evaluating repair of peripheral nerve injury.
Highlights
Nerve EMG can be used to more objectively assess the nerve function recovery, it is not intuitive and easy to interpret and determine
When high-frequency ultrasound was used to test PGLA nerve conduits in the human body at one postoperative month, the conduits presented black and low-density regions, and still no disconnection was observed between the regenerated superficial radial nerve and the distal stoma (Fig. 1)
It is believed that compared with the evaluation of nerve function, studies on the morphology of a regenerated nerve allow clinicians to determine the growth of the regenerated nerve in advance, which is conducive to judging and intervening nerve regeneration in the early stage after neural prosthesis with nerve conduits
Summary
Nerve EMG can be used to more objectively assess the nerve function recovery, it is not intuitive and easy to interpret and determine. In previous animal experiments on artificial nerve conduits for the repair of nerve defects, various histological and immunological methods have been adopted to count regenerated nerve fibers, directly observe micro morphology, analyze morphology and wet weight of target muscles, and even analyze proteomics variation These methods are objective and intuitive; they enable to observe samples collected at any time point during the follow-up. This study used high-frequency ultrasound and fMRI techniques to explore the feasibility for determining the morphology and functional recovery of regenerated nerves after neural prosthesis with PGLA nerve conduits, with the objective to provide a method that can be used to timely, objectively, and intuitively determine nerve regeneration after neural prosthesis with PGLA nerve conduits, and evidence for optimizing clinical evaluation strategies after neural prosthesis with nerve conduits
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