周围神经损伤5 22 Peripheral Nerve Injury.pptx

Peripheral Nerve Injury;Index;Consisted of 31 pairs of spinal nerves Mixed of sympathetic, sensory and motor nerves Structure four main plexus: the cervical , brachial, lumbar and sacral plexus.;;Pathology;1 weeks after injury, proximal shaft cable generates a lot of shoot If the nerve ends are connected, proximal regenerated nerve fiber could regenerate into myelin sheath formed by proliferated Schwann cell If the nerve ends don’t connected, proximal nerve fiber regenerates and spherical enlarges which is called pseudoneuroma ;;;Sunderland 5 degrees classification;;flaccid paralysis of dominated muscles, Muscle tension and reflex all disappeare Special deformity;Feeling lost of dominated skin Because of the overlap of sensory fiber, actually the feeling totally only disappears in a small area, called absolute domination region of nerve ;;The peripheral nerve contains sympathetic nerve Nutritional changes could be seen in Nails, fingers, skin, etc. The secretion of sweat gland is aborted and the skin is dry.;When HCP taps the nerve corresponding plane, the pts will diffuse pain and inductance in nerve distributed area , which is caused by axon exposure and neuroticism phenomenon in nerve regeneration process.;Neurolysis;;Neurorrhaphy; 1. Neural stem grafting  2. Bundle nerve cable type grafting ;Proximal damaged unable to suture Another nerve bundle is not important Shift the proximal to the distal damage of more important nerve. Restore the muscle function ; Never implementation;;Index;Brachial plexus injury;characteristic： 1. Almost stretch 2. Multiple nerve injury 3. Partial irreversible root avulsion injury 4. Poor operation effect ;Manifestation;Root avulsion ： proximal or distal;Radial nerve injury;Low (elbow) radial nerve injury; High (middle upper arm) radial nerve injury;Higher (axillary) radial nerve injury;Median nerve injury;Low (wrist) median nerve injury; Deformity - missionary hand 1. Paralysis of flexor pollicis longus tendon, index+middle