周围神经损伤显微外科修复.docVIP

周围神经损伤显微外科修复【摘要】 目的 分析应用显微外科技术修复周围神经损伤的临床疗效。方法 自1997～2009年，用显微外科技术修复周围神经损伤176例197条神经，方法包括神经外膜缝合术、神经束膜缝合术、神经松解术及神经移植术。结果 术后经3～60个月随访，根据BMRC感觉、运动评价标准，其中疗效为优者84条，良者77条，优良率达81.73%。伤后24 h内修复者的优良率为93.52%，优于3个月内修复者。3个月内修复者优良率为79.31%，优于6个月后修复者。结论 应用显微外科技术对周围神经损伤的早期修复和显微镜下神经断端的精确对合可提高临床疗效。 【关键词】 周围神经；损伤；修复；显微外科技术 Microsurgical reparation of peripheral nerve injury PENG De-fei，LI Zi-li，CHENG Dai-wei，et al.Department of Plastic Surgery，Guizhou Province Peoples Hospital,Guiyang 550002，China. 【Abstract】 Objective To analyze the curative effect that microsurgical technique used in peripheral nerve injury. Methods One hundred and seventy-six cases（197 nearal） of peripheral nerve injury were treated with microsurgical technique from 1997 to 2009. The operations used in this group include epineurial repair，fascicular repair，epineurial-fascicular repair，neurolysis and nerve grafting. Results All cases were followed up after 3 months to 60 months. According to the assessment criterion of nerve function issue by the BMRC. The overall excellent and good rate was 81.73%.The treatment outcome was much better in those managed with in 25 h than those managed 3 mouths （93.52%）.The treatment outcome was much better in those managed within 3 months than those managed 6 months later （79.31%）.Conclusion The preceded microsurgical repair of peripheral nerve injury is an effective method for raising the excellent rate of peripheral nerve injuries. 【Key words】 Peripheral nerve; Injury; Repair; Microsurgical technique 周围神经损伤临床十分常见，应用传统的治疗方法进行治疗，临床疗效通常都比较差。而用显微外科技术修复周围神经损伤使其疗效有了显著提高。我院自1997～2009年来应用显微外科技术修复周围神经损伤176例，共197条。术后经3～60个月随访，疗效满意。 1 资料与方法 1.1 一般资料 本组176例，其中男144例，女32例。年龄5～66岁，平均36岁。损伤原因：切割伤92例，机械伤和车祸伤79例， 医源性损伤5例。受伤距治疗时间最短1 h，最长48个月。损伤神经：坐骨神经15条，腓总神经32条，胫神经18条，股神经3条，正中神经40条，尺神经46条，桡神经43条。合并骨折、肌肉肌腱其他神经损伤128例。修复方法：束膜缝合48例，外膜缝合100例，自体腓肠神经移植15条，神经松解34条。 1.2 手术方法 应用显微外科技术，按神经外膜滋养血管的走向位置或神经束的形态、方位在无张力情况下用9-0无损伤缝线作外膜、束膜缝合。对陈旧性神经损伤，由于断端回缩和切除神经瘤所造成2～4 cm以内缺损者，采用游离神经断端，屈曲关节等处理可