双端侧神经吻合修复指固有神经缺损  

Double end-to-side neuroanastomosis for repairing bilateral proper digital nerve defects

作　　者：江起庭 王钰[2] 杨丽娜 江志伟[3] 

机构地区：[1]巢湖紫晨手外科医院手外科中心,安徽巢湖238000 [2]沈阳医学院附属中心医院沈阳市手外科研究所,辽宁沈阳110024 [3]南京军区南京总医院全军普外科研究所,江苏南京210002

出　　处：《外科研究与新技术》2013年第4期240-242,共3页Surgical Research and New Technique

基　　金：江苏省科技计划重点资助项目(BS2008063);南京军区科技创新重点资助项目(08Z026)

摘　　要：目的 介绍一种修复双侧指固有神经缺损的手术新方法.方法 2010年3月至2013年1月收治双侧指固有神经缺损患者17例.术中游离修剪神经残端,将远端尺、桡侧指固有神经先吻合,形成远神经弓,再将近端尺、桡侧指固有神经吻合,形成近神经弓;测量两神经弓间距,取直径相近的前臂外侧皮神经,平分为两段,分别于神经弓的尺、桡侧开窗端侧吻合.结果 术后创面均Ⅰ期愈合,患指均成活.术后3.5~6.8个月,平均4.7个月随访,患指感觉恢复S2+~S4级,平均S3级,两点分辨觉5.2~8.5 mm,平均6.45 mm;患指各关节活动度参照TAM系统评定:优11例,良4例,可2例,优良率为88.2%.结论 带神经弓式的双端侧神经吻合可成功的修复指固有神经缺损,指感觉恢复快,有效的恢复指腹灵敏性.Objective To provide the new method for repairing bilateral proper digital nerve defects. Methods From March 2010 to January 2013,17 patients with bilateral proper digital nerve defects were admitted to our center. During operation,the injured digital nerve was excised,then bilateral distal ends and proximal ends were sutured, respectively; consequently,the distal and proximal nerve bows were formed. A cutaneous antebrachii lateralis nerve was freed and obtained from the homolateral forearm,then divided equally to 2 parts which were used to bridge the 2 nerve bows. Results All the patients achieved primary healing of wound after operation,17 fingers recovered uneventfully. Postoperative follow-up interval ranged from 3. 5 to 6. 8 months,with an average of 4. 7 months. The sensation of fingertip recovered ranged from S2 to S4( mean S3) and the two point discrimination ranged from 5. 2 to 8. 5 mm( average,6. 45 mm) in 17 cases. According to the total active movement( TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975,the results were excellent in 11 cases,good in 4 cases,and fair in 2 case,and the excellent and good rate was 88. 2%. Conclusion The arched nerves of double end-to-side neuroanastomosis is valuable method for repairing bilateral proper digital nerve defects.

关 键 词：端侧神经吻合 指固有神经 修复外科手术 

分 类 号：R651.3[医药卫生—外科学]