周围神经和中枢神经损伤因缺乏有效的治疗选择而在临床实践中面临重大挑战。细胞外囊泡（EVs）是大多数细胞类型释放的脂质膜包封纳米颗粒，富含能够介导细胞间通讯的生物活性分子。近年来，EVs在再生医学中展现出应用前景，尤其可作为细胞治疗的替代方案。以EVs为基础的神经损伤治疗正迎来治疗范式的转变。越来越多的证据表明，EVs主要通过调节神经细胞功能、免疫炎症反应和血管生成来促进神经再生和功能恢复。目前已开发出多种策略将EVs整合到神经移植物中，或将其用作诊断和治疗载体。本综述旨在系统梳理现有文献中关于EVs治疗周围神经损伤、脊髓损伤和脑损伤的最新进展，并从深层机制理解、技术创新和学科交叉融合等方面讨论了基于EVs的神经损伤修复的前景。

Peripheral and central nerve injuries present significant challenges in clinical practice due to the paucity of effective therapeutic options. Extracellular vesicles (EVs), lipid membrane-encapsulated nanoparticles released from most cell types, are enriched in bioactive molecules capable of mediating intercellular communication. Recently, EVs have shown potential for applications in regenerative medicine, notably as alternatives to cell therapy. A therapeutic paradigm shift is emerging towards the EV-based treatment of nerve injury. Accumulating evidence indicates that EVs promote nerve regeneration and functional recovery, primarily by modulating neural cell function, immune-inflammatory responses, and angiogenesis. Various strategies have been developed to incorporate EVs into nerve grafts or to utilize them as diagnostic and therapeutic vehicles. This review aimed to provide a systematic survey of the available literature on the latest progress in EV-based treatments for peripheral nerve, spinal cord, and brain injuries. Additionally, prospects of EV-based nerve injury repair are discussed in terms of deep mechanistic understanding, technological innovations, and interdisciplinary convergence.