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    188宝金博页面版: 10.1An evaluation of a controlled release glass wrap in the repair of peripheral nerves

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    内容提示： 10.1 AN EVALUATION OF A CONTROLLED RE-LEASE GLASS WRAP IN THE REPAIR OF PERIPH-ERAL NERVESL. Jeans 1 , T. Gilchrist 2 and D. Healy 21 Ninewells, UK;2 Giltech Ltd, Ayr, UKBackground and aims: A biodegradable controlledrelease glass has recently been manufactured in a f l exiblewrap form, the CRG-wrap. In this study, the use of theCRG-wrap was evaluated and compared to microsurgi-cal epineurial suturing in the repair of cleanly dividedperipheral nerves.Methods: Five groups of twelve sheep were used; onecontr...

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    10.1 AN EVALUATION OF A CONTROLLED RE-LEASE GLASS WRAP IN THE REPAIR OF PERIPH-ERAL NERVESL. Jeans 1 , T. Gilchrist 2 and D. Healy 21 Ninewells, UK;2 Giltech Ltd, Ayr, UKBackground and aims: A biodegradable controlledrelease glass has recently been manufactured in a f l exiblewrap form, the CRG-wrap. In this study, the use of theCRG-wrap was evaluated and compared to microsurgi-cal epineurial suturing in the repair of cleanly dividedperipheral nerves.Methods: Five groups of twelve sheep were used; onecontrol group, and four repair groups, which were; (1)microsurgical epineurial repair, (2) CRG-wrap and 6/0polyglactin, (3) CRG-wrap and f i brin glue, (4) CRG-wrap and polycaprolactone glue. The median nerve inthe upper forelimb of each sheep was divided byneurotmesis. The nerve was then repaired immediatelyusing one of the methods listed above. No gap was leftbetween the cut ends. The outcomes of the repairs wereassessed after 7 months by electromyography, nerveconduction studies, wet muscle mass measurements, andmorphometry. Transcutaneous stimulated jitter (TSJ)assesses the maturity of the motor end-plates and wasused to assess muscle f i bres in the f l exor carpi radialis(FCR). The maximum conduction velocity (CV max ) wasmeasured across the sites of repair in each group. Thewet muscle mass of FCR was measured. A section ofnerve 2cm distal to the site of repair was excised, themean axon diameter and the f i bre diameter weremeasured using light microscopy and a computer imageanalysis programme. Myelin sheath thickness and g-ratio were then calculated. Testing was carried out onthe operated and non-operated limbs and the ratio ofthese measurements in each sheep used in the statisticalanalyses.Results: The CRG-wrap secured with Tisseel glue was aseffective as microsurgical epineurial suturing.Conclusion: The repair of peripheral nerves using theCRG-wrap is easy to learn, quicker and cheaper thanmicrosurgical epineurial suturing and could be carriedout by anyone with basic surgical skills. The CRG-wrapis a useful alternative to microsurgical epineurial repair.10.1016/j.jhsb.2006.03.06010.2 DOES PRESERVATION OF THE TENOSYNO-VIAL LINING OF THE CARPAL TUNNEL IMPROVETHE OUTCOME OF CARPAL TUNNEL SURGERY? ARANDOMIZED-CONTROLLED TRIALD. Forward, A. Singh, T. Lawrence, J. Sithole, T. R.C. Davis and J. OniQueen’s Medical Centre, Nottingham, UKBackground: It was postulated that the preservation of alayer of gliding tissue between the contents of the carpaltunnel and the soft tissues incised during carpal tunnelsurgery might reduce scar pain in the immediatepostoperative period.Patients: We performed a prospective randomized-controlled study in 118 patients to evaluate whetherpreserving the f l exor tenosynovium at the time of opencarpal tunnel decompression improved the outcome ofsurgery.Results: Grip strength and completion of a validatedself-administered questionnaire were used to comparepre- and post-operative symptoms and function. Seventy-seven women and 34 men were reviewed at between 8and 9 weeks following surgery, with the remaining sevenlost to follow-up. All underwent standard open carpaltunnel decompression and had been randomized tohaving the f l exor tenosynovium preserved or divided atthe time of surgery. The tenosynovium was preserved in53 patients and divided in 58.Discussion: Preserving the tenosynovial lining of thef l exor sheath produced no signif i cant benef i t comparedto releasing it. Grip strength and scar pain were notsignif i cantly different between the two groups. Self-ratedoutcome also showed no signif i cant difference betweengroups.Conclusion: We conclude that in this group of patientspreservation of the f l exor tenosynovium at the wristduring open carpal tunnel release produced no signif i -cant difference in grip strength or self-rated symptoms.10.1016/j.jhsb.2006.03.061ARTICLE IN PRESSNERVES 1 47

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