神经束间侧侧缝接预防高位神经损伤后不可逆肌萎缩  

Side-to-side neurorrhaphy of nerve tract to avoid irreversible atrophy of denervated skeletal muscle after superior peripheral nerve injury

作　　者：张少成[1] 马玉海 孙来卿[1] 朱亚中[2] 付强[1] 张燕鹏[1] 张秋林[1] 

机构地区：[1]第二军医大学长海医院骨科,上海市200433 [2]解放军第九十八医院骨科,浙江省湖州市313000

出　　处：《中华创伤骨科杂志》2005年第4期335-337,340,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨一种预防高位神经损伤后远端效应器官不可逆性肌肉萎缩的新方法。方法首先将高位神经损伤处如臂丛根、干部、坐骨神经出口部等,常规进行探查修复。然后在尽量接近受损伤神经所支配的主要效应器官的部位,将损伤神经与邻近的正常神经相互靠拢,切开两神经相对应侧的神经外膜和束膜1～1.5cm后,将切开处相互紧密并拢,用9-0～11-0显微外科针线分别将两条神经的束、外膜相互侧侧缝合。结果21例患者经术后2～5年(平均3.2年)随访,其中5例达到M4/S4,8例达到M3/S3,5例为M3/S2,3例为M2/S2。明显优于对照组相同部位损伤采用相同方法修复但未做远端侧侧缝合的病例,因为后者无1例达到M4/S4。结论高位神经损伤在进行常规修复的基础上,将其远端与邻近的正常神经行侧侧缝合对预防远端效应器官的不可逆性肌萎缩有一定效果。Objective To explore a new method to prevent irreversible atrophy of denervated skeletal muscle after superior peripheral nerve injury. Methods After the injured superior peripheral nerve, such as the root or trunk of brachial plexus and the outlet of sciatic nerve, was routinely explored and repaired, the injured nerve and the neighboring normal one were drawn close. Their epineurium and perineurium were incised longitudinally 1 to 1.5 cm at a suitable site to expose the nerve fibers, and then the epineurium and perineurium of the two nerves were anastomosed by side to side neurorrhaphy with 9 to 11 microsurgical threads of Number 0. Results 21 patients underwent this procedure and were followed up for 2 to 5 years ( 3.2 years on average). 5 of them attained functional recovery to M4/S4, 8 to M3/S3, 5 to M3/S2 and 3 to M2/S2. Compared with patients with similar nerve injury who were repaired routinely without side to side neurorrhaphy, these results were significantly better because none of the routinely repaired patients attained M4/S4 recovery. Conclusion Routine nerve repair combined with side to side neurorrhaphy is an effective method to avoid irreversible atrophy of denervated skeletal muscle in treatment of superior peripheral nerve injury. [

关 键 词：神经损伤 肌萎缩 修复 侧侧缝合 神经束 

分 类 号：R651.3[医药卫生—外科学]