周围神经损伤早期显微外科修复.docVIP

周围神经损伤早期显微外科修复 　 作者：邓红平 王之宇 林格生 方基石 【摘要】 目的 探索周围神经损伤早期显微外科修复的临床效果及预后。方法 根据神经损伤的部位及程度应用不同的显微外科方法进行修复。具体方法为神经探查、神经松解、神经外膜修补、神经外膜端端吻合、神经束膜端端吻合、神经移植、神经移位、神经植入等。 结果 共修复周围神经118例12条166处，获随访72例12条98处，运动功能恢复达M3以上31.82%，感觉功能恢复达S3以上67.74%，其中前臂内外侧皮神经、股外侧皮神经、腓肠神经损伤修复后感觉恢复均达到S3，28处指神经损伤修复后感觉恢复达S3以上占82.14%，尺神经、腓总神经的运动功能无一例恢复，桡神经及股神经的运动功能恢复最理想。结论 应用显微外科技术早期修复周围神经损伤效果良好，但应注意修复时机及方式。 【关键词】 四肢 神经 损伤 显微外科技术 　　【Abstract】 Objective To explore the clinical effect and prognosis of Early repair of injured peripheral nervous with microsurgery technique. Methods Treating peripheral nervous injury with different microsurgery operations according to the position and degree of injury. Methods include nerve explore,neurolysis,epineural suture,interfascucular suture, nerve anastomosis, neural transplantation, nerve transposition,neurotization. Results 118 cases and 12 twigs and 166 places peripheral nervous injury were treated .72 cases and 12 twigs and 98 places were followed up for average 14.3 months (range 7-24months). The motor function recovery was above M3 in 31.82%,the sensory function recovery was above S3 in 67.74%; among them , the sensory function recovery above S3 rate was 100% at medial or lateral antebrachial cutaneous nerves,lateral fenoral cutaneous nerves and sural nerves, and 82.14% at 28 twigs digital nerves. In motor function, ulnar nerve and common peroneal nerve repair had none recovery , radial nerve and fenoral nerve repair had the best recovery . Conclusions Early operation with microsurgery-technique has a good therapeutic effects in repairing peripheral nervous injuries , yet the right time and specific operating methods should be paid attention too. 　　【Key words】Extremities Nerve injury Microsurgery-technique 　　周围神经损伤是骨科临床常见的损伤，因受周围神经本身再生特点的影响，其修复过程缓慢且难以预料。随着人们生活水平的提高，对医疗的要求也提高了，如过去基层医院不予重视的皮神经、指神经损伤，也会因延误诊断、处理不及时而出现医患纠纷。如何提高周围神经损伤的诊治水平是骨科、显微外科医生义不容辞的责任。2004年5月至2006年6月，本科共诊治周围神经损伤118例，现分析报告如下。 　　1 资料与方法 　　1.1 一般资料 　　本组118例，其中男71例，女47例，年龄5～65岁(平均32.5岁)。损伤原因：玻璃划伤42例，刀割