硬脊膜内松解自体周围神经植入治疗脊髓陈旧性不完全性断裂伤.DOCVIP

临床医学论文-硬脊膜内松解自体周围神经植入治疗脊髓陈旧性不完全性断裂伤 ??????????????? 作者：郑旭东　张少成　梁俊刚　黄进　杨恺 【摘要】? ：［目的］探讨脊髓减压松解、神经组织植入治疗陈旧性脊髓不完全性断裂伤的临床效果。［方法］对16例外伤性陈旧性不全瘫患者,采用显微外科技术切开硬脊膜,将蛛网膜、软脊膜、齿状韧带、神经根起始段与脊髓的粘连及周围的纤维条索彻底解除。将质地外观异常段的脊髓行3～6个切口纵行切开;若发现脊髓内囊肿,则切开后吸出其中液体。然后,将自身腓肠神经用显微外科方法去除外膜、束膜并剪开,将其排列呈多条状、纵行植入已切开的脊髓处或原囊肿腔内。最后修复硬脊膜或用骶棘肌瓣覆盖。［结果］16例患者术后随访2～4年(平均2.5年),感觉和运动均增加1级以上,其中6例双下肢主要肌群肌力较术前增加2级,恢复达4级,恢复行走能力。［结论］硬脊膜内粘连松解、瘢痕段脊髓切开、自体周围神经组织植入桥接治疗外伤性陈旧性不全瘫患者的初步临床观察效果良好。 【关键词】? 脊髓损伤　显微外科　硬脊膜内松解　周围神经移植??? 　　Abstract：［Objective］To research the later period treatment for the traumatic incomplete paralysis.［Method］Sixteen patients who suffered from traumatic obsolete incomplete paralysis underwent intradurallysis and peripheral nerve implantation by microsurgery technique.The endorachis was opened,and the fibrous bands adhering to the spinal cord.from arachnoid,pia mater spinalis,ligamenta denticulatum,initiative part of never root were completely relieved.The abnormally watched spinal cord was opened by 3-6 incisions.The cyst found in the spinal cord was opened and the liquid in it was drained.After that,denuded spineurium and perineurium of the autogenous sural nerve was grafted.The nerves were lined up into several strips and longitudinally implanted into the incised spinal cord and cyst.And it was sutured with pia mater spinalis.Finally,the endorachis was sutured or covered by sacrospinal muscle.［Result］Sixteen patients were followed up for 2-4 years (mean 2.5 years).The sensibility and motion increased by at least one grade.The strength of main muscle was increased by 2 grades and reached 4 grades and the walking capability was recovered in six patients.［Conclusion］The initial good clinical results were obtained for patients with traumatic obsolete incomplete paralysis by relieving the adhesion in the endorhachis,carving the cicatricial spinal cord and implanting the autogenous peripheral nerve. ??　? Key words：spinal cord injury;? microsurgery;? obsolete paraplegia;? peripheral nerve implantation