内窥镜技术结合NAP早期判断尺神经缝合后再生质量的临床应用  

Endoscopic technique combining with NAP in early judgment of repair quality of ulnar nerve:clinical application

作　　者：陆九州[1] 徐文东[1] 张凯莉[1] 朱艺[1] 徐建光[1] 顾玉东[1] 

机构地区：[1]复旦大学华山医院手外科,上海200040

出　　处：《中华手外科杂志》2004年第3期155-156,共2页Chinese Journal of Hand Surgery

摘　　要：目的　介绍应用内窥镜技术结合测定神经干动作电位 (nerveactionpotention ,NAP)以早期判断肘部尺神经缝合后再生质量的新技术。方法　对 7例尺神经断伤后直接修复者 ,通过 2个 1.5cm长的切口 ,在内窥镜下行缝合神经的探查、松解术及功能性电刺激 5～ 10min。测定神经松解术前后的NAP ,比较其波幅及神经传导速度以判断神经的再生质量及手术效果。结果　术中 6例神经松解术前的NAP示有效神经再生 ,但经神经松解及功能性电刺激后尺神经缝合口远端的NAP波幅与神经传导速度比术前分别改善了 3 0 %和 9.8%。 1例患者神经缝合口瘢痕增生严重 ,且邻近肱动脉 ,改行开放性手术。结论　内窥镜技术结合神经松解术前的NAP测定 ,可早期判断神经缝合后的再生质量。内窥镜下同时作神经粘连松解、功能性电刺激 ,结合神经松解后NAP的测定结果 ,证实该技术可提高尺神经修复后的治疗效果。Objective To apply endoscopic technique combining with nerve action pstentiae(NAP) in the early judgment of the repair quality of ulnar nerve. Methods Seven patients with injured ulnar nerves were involved in this study. With two 1.5-centimeter-long incisions, injured ulnar nerves went through exploration and neurolysis through an endoscope. NAP was measured to judge the quality of nerve regeneration, and the amplitude and NCV of NAP were compared before and after surgery to observe the operative effects. Postoperative patients were followed-up periodically to observe their motor, sensory function and electrophysiological changes to examine the efficacy of NAP measurement. Results Endoscopic operations were performed successfully on 6 out of 7 patients, and intraoperative NAP measurement showed effective nerve regeneration. The amplitude and NCV of NAP measured in the injured nerves that went through exploration and functional electrical stimulation improved 30% and 9.8% respectively. One patient went through open surgery because of his highly proliferative scars in the stoma region and its position near the brachial artery. Periodically postoperative follow-up showed good nerve regeneration and effective recovery of nerve unction. Conclusion Endoscopic technique can be used in the early exploration and neurolysis of injuried peripheral nerves. Combining with NAP the technique can be applied in the early judgment of the repair quality ulnar nerve, and intraoperative functional electrical stimulation can be conducted meanwhile as an effective treatment, which have important significance in judging the repair quality and improving the treatment outcome of injured ulnar nerves. Besides, it is a valuable minimally invasive technique offering quick recovery.

关 键 词：尺神经 缝合 内窥镜技术 NAP 术前 临床应用 功能性电刺激 结论 判断 目的 

分 类 号：R651.3[医药卫生—外科学] R51[医药卫生—临床医学]