闭孔神经移位修复腰骶丛神经根撕脱伤的解剖学观察及临床应用  

Obturator nerve transfer to repair lumbosacral plexus nerve root avulsion injuries： anatomic study and clinical application

作　　者：王树锋[1] 薛云浩[1] 刘佳勇[1] 栗鹏程[1] 褚寅[1] 熊革[1] 孙燕琨[1] 

机构地区：[1]北京大学第四临床医学院北京积水潭医院手外科,100035

出　　处：《中华骨科杂志》2009年第5期387-392,共6页Chinese Journal of Orthopaedics

摘　　要：目的观察闭孔神经移位修复腰骶丛神经根撕脱伤的可行性及临床疗效。方法取15具成人尸体标本，显露双侧闭孔神经及腰骶丛神经根。测量闭孔神经从主干起始部至闭孔入口处的长度及其在闭孔入口处的横径和纵径，计算横截面积，并在高倍显微镜下计数有髓神经纤维数目。以相同方法测量并计算股神经相应指标。2002年1月至2007年9月，共为5例腰骶丛损伤患者进行闭孔神经移位术。行健侧闭孔神经经椎体前腹膜后通路移位与患侧股神经直接吻合4例，闭孔神经移位与同侧S1神经根直接吻合1例。结果闭孔神经的平均长度为（10．5±0．9）cm，横径（2．03±0．37）mm，纵径（2．78±0．29）mm，有髓神经纤维数目（5974±1996）根；股神经横径（3．79±0．58）mm，纵径（6．53±0．61）mm，有髓神经纤维数目（15860±4350）根。术后3-7d，所有患者供肢内收肌肌力均减弱至2-3级；术后3个月，4级2例，3级2例，2级1例（至术后1年时，内收肌肌力恢复3级）。4例修复患侧股神经的患者，术后分别随访8个月～5年，股四头肌肌力4级2例，2级1例，1级1例；1例行闭孔神经移位与同侧S，神经根直接吻合的患者，术后11个月时小腿三头肌及屈趾肌肌力恢复至3级。结论闭孔神经可作为一个安全有效的动力神经源，用其修复腰骶丛神经根撕脱伤可获得满意疗效。Objective To provide an effective and safe motor donor nerve for the treatment of lumbosacral plexus nerve root avulsion injuries. Methods The obturator nerve, lumbar plexus and sacral plexus on both sides were exposed on 15 cadaver specimens. The length of obturator nerve was measured from its origin to entrance of the foramen obturatum. The transverse diameter and thickness of the obturator nerve and femoral nerve on both sides were measured individually. The obturator nerve and femoral nerve of each specimen was cut into histological slice, and the amount of myelinated nerve fiber was counted respectively. There were five patients including 4 patients with traumatic lumbosacral plexus nerve root avulsion injuries and 1 patient with lumbar plexus nerve root injuries. The contralateral obturator nerve as motor donor nerve transferred through the retroperitoneal route and direct coaptation with the femoral nerve was performed in 4 cases, and ipsilateral obturator nerve was transferred to the Sl nerve root in 1 case. Results The length, transverse diameter and thickness of the obturator nerve was （10.5±0.9） cm, （2.03±0.37） mm and （2.78±0.29） mm individually. The transverse diameter and thickness of femoral nerve were （3.79±0.58） mm, （6.53±0.61） mm individually. The obturator nerve contained 5974±1996 myelinated nerve fibers and the femoral nerve contained 15 860±4350 myelinated nerve fibers. In 3-7 d after the operation, the muscle strength of adduction on the donor lower limber was decreased to grade 2-3. The functional recovery of muscle strength of quadriceps reconstructed by contralateral obturator nerve transfer recovered to grade 4 in 2 cases, grade 2 in 1 case and grade 1 in 1 case between 8 months to 5 years postoperatively. The muscle strength of triceps surae and finger flexor reconstructed by ipsilateral obturator nerve transferring to S1 nerve root recovered to grade 3 after 11 months postoperatively. Conclusion The contralateral or ipsilateral obturator nerve can be used as

关 键 词：腰骶丛 创伤和损伤 神经移位 闭孔神经 

分 类 号：R686[医药卫生—骨科学]