| 周围神经损伤的修复治疗 |
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Received:December 15, 2004
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李平生 |
LI Ping-sheng |
解放军第九十五医院骨科,福建莆田351100 |
Department of Orthopaedics,the 95th Hospital of PLA,Putian 351100,Fujian,China |
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| 林国叶 |
LIN Guo-ye |
解放军第九十五医院骨科,福建莆田351100 |
Department of Orthopaedics,the 95th Hospital of PLA,Putian 351100,Fujian,China |
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| 何向阳 |
HE Xiang-yang |
解放军第九十五医院骨科,福建莆田351100 |
Department of Orthopaedics,the 95th Hospital of PLA,Putian 351100,Fujian,China |
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| 阮雄星 |
RUAN Xiong-xing |
解放军第九十五医院骨科,福建莆田351100 |
Department of Orthopaedics,the 95th Hospital of PLA,Putian 351100,Fujian,China |
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| 王怀云 |
WANG Huai-yun |
解放军第九十五医院骨科,福建莆田351100 |
Department of Orthopaedics,the 95th Hospital of PLA,Putian 351100,Fujian,China |
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| 方国芳 |
FANG Guo-fang |
解放军第九十五医院骨科,福建莆田351100 |
Department of Orthopaedics,the 95th Hospital of PLA,Putian 351100,Fujian,China |
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| 期刊信息：《中国骨伤》2005年18卷，第11期，第667-669页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:探讨影响周围神经损伤修复的因素,以提高周围神经损伤修复的疗效。
方法:周围神经损伤186例186条,男146例,女40例;年龄10~67岁。尺神经32条,桡神经65条,正中神经根24条,坐骨神经19条,腓总神经18条,股神经9条,胫后神经11条,腋神经6条,肌皮神经2条。新鲜损伤Ⅰ期缝合神经,缺损>2.5 cm的酌情行自体神经移植术。陈旧性损伤根据损伤情况分别行神经缝合术、神经移植、神经松解术。116条全断神经,其中76条采用肉眼下外膜缝合;18条显微镜下外膜缝合或束间固定加外膜缝合;22条行自体神经移植:移植神经取自腓肠神经19条,上臂内侧皮神经3条。神经部分断裂挫伤16条,行束间移植10条,肌桥吻合移植6条。神经挫伤、瘢痕粘连54条,行肉眼下外膜松解39条,显微镜下外膜加束膜松解15条。
结果:上肢神经损伤中桡神经损伤修复优良率79.2%,尺神经优良率30.76%。下肢神经损伤中胫神经及股神经修复优良率83.1%和71.4%,腓总神经和坐骨神经优良率50%和42.8%。
结论:周围神经损伤后应争取尽早手术修复,显微镜下外膜缝合能有效地预防神经挫伤引起的瘢痕粘连,当神经缺失>2.5 cm行自体神经移植术有利于神经再生。 |
| [关键词]:周围神经 损伤 神经外科手术 |
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| Repairing treatment of peripheral nerve injuries |
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Abstract:
Objective:To explore the factors of influence in repairing the peripheral nerve injuries to raise the therapeutic effect.
Methods:One hundred and eighty-six patients(146 male,40 female;the age from 10～67 years;186 nerves)with peripheral nerve injuries.There were 32 ulnar nerves,65 radial nerves,24 median nerves,19 sciatic nerves,18 common peroneal nerves,9 femoral nerves,11 posterior tibial nerves.The nerves of fresh injuries were sutured on the first stage,and the defect(>2.5 cm)were treated by nerve grafting.The old injuried nerves based on the different injury conditions and selected the operative methods including neurorrhaphy,nerve grafting and neurolysis respectively.Among 116 nerves of ruptured,there were 76 nerves by directly epineurium suture,18 nerves by suture of epineurium or epineurial-interfascicular under microscope,22 nerves by nerve grafting(the nerve graft from 19 sural nerves and 3 upper medial brachial cutaneous nerves).Among the 16 nerves of partly ruptured,there were 10 nerves by interfascicular grafting and 6 nerves by embedding nerve bundle in the paralyzed muscle.Among the 54 scar adhered nerves,there were 39 directly epineurium neurolysis and 15 epineurial-fascicular neurolysis under microscope.
Results:For the upper limbss,the rate of excellent and good was 79.2% in reparing of radial nerve,and 30.76% in ulnar nerve.For the lower limbs,the rate of excellent and good was 83.1%,71.4%,50% and 42.8% in reparing of tibial nerve,femoral nerve,common peroneal nerve and sciatic nerve respectively.
Conclusion:Early operation is good for the injuries of peripheral nerves.Epineurium suture under microscope could effectively prevent from formation of the scars and adhesion in injuried peripheral nerves.If the length of nerve defect is more than 2.5 cm,nerve grafting is helpful for nerve regeneration. |
| KEYWORDS:Peripheral nerves Injuries Neurosurgical procedures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李平生,林国叶,何向阳,阮雄星,王怀云,方国芳.周围神经损伤的修复治疗[J].中国骨伤,2005,18(11):667~669 |
| 英文格式: | LI Ping-sheng,LIN Guo-ye,HE Xiang-yang,RUAN Xiong-xing,WANG Huai-yun,FANG Guo-fang.Repairing treatment of peripheral nerve injuries[J].zhongguo gu shang / China J Orthop Trauma ,2005,18(11):667~669 |
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