Postoperative electrical stimulation (PES) improves nerve regeneration by decreasing staggered regeneration at the coaptation site. By contrast, conditioning (preoperative) electrical stimulation (CES) accelerates axon extension. Given that both techniques can be delivered at the bedside, a direct comparison of outcomes is of significant clinical importance. In this study, we compared regeneration and reinnervation outcomes of CES, PES, a combination of CES and PES, and a no stimulation control. Sprague Dawley rats were randomly divided into i) CES, ii) PES, iii) CES + PES, and iv) no stimulation. CES was delivered one week prior to nerve cut/coaptation, and PES was delivered immediately following nerve repair. Length of nerve regeneration was assessed at 7 days post-coaptation (n = 6/cohort), and behavioral testing was performed between 6 and 8 weeks post-coaptation (n = 8/cohort). Animals treated with CES had significantly longer axon extension and improved sensorimotor recovery compared to all other cohorts. CES treated axons extended 8.5 ± 0.6 mm, significantly longer than PES (5.5 ± 0.5 mm), CES + PES (3.6 ± 0.7 mm), or no stimulation (2.7 ± 0.5 mm) (p < .001). Sensory recovery (von Frey filament testing, intraepidermal nerve fiber reinnervation) (p < .001) and motor reinnervation (horizontal ladder, gait analysis, nerve conduction studies, neuromuscular junction analysis) (p < .05 - p < .001) were significantly improved in CES animals. CES significantly improves regeneration and reinnervation beyond the current clinical paradigm of PES. The combination of CES and PES does not have a synergistic effect. CES alone therefore may be a more promising treatment to improve outcomes in patients undergoing nerve repair surgeries.

中文翻译：

---

调理电刺激优于术后电刺激，可增强神经再生和功能恢复。

术后电刺激（PES）通过减少接合部位的交错再生来改善神经再生。相反，调节（术前）电刺激（CES）可加速轴突延伸。鉴于两种技术都可以在床旁进行，因此直接比较结局具有重要的临床意义。在这项研究中，我们比较了CES，PES，CES和PES的组合以及无刺激控制的再生和神经支配结果。将Sprague Dawley大鼠随机分为i）CES，ii）PES，iii）CES + PES和iv）无刺激。CES在神经切断/接合之前一周交付，而PES在神经修复后立即交付。适应后7天评估神经再生的长度（n = 6 /组），在适应后6至8周内进行了行为测试（n = 8 /组）。与所有其他队列相比，用CES治疗的动物的轴突延伸时间更长，感觉运动恢复也更好。CES处理的轴突延伸8.5±0.6 mm，明显长于PES（5.5±0.5 mm），CES + PES（3.6±0.7 mm）或无刺激（2.7±0.5 mm）（p <.001）。感觉恢复（von Frey细丝测试，表皮内神经纤维神经支配）（p <.001）和运动神经支配（水平梯，步态分析，神经传导研究，神经肌肉接头分析）（p <.05-p <.001）显着在CES动物中得到改善。CES大大改善了PES的当前临床范式之外的再生和神经支配。CES和PES的组合没有协同作用。