骨骼肌包埋神经片段桥接与神经移植修复神经缺损的比较  

Comparison of Implantation of Nerve Fragment Embedded in Skeletal Muscle Fibers With Nerve Grafting in the Treatment of Peripheral Nerve Defects

作　　者：万智勇[1] 张帆[1] 陈初勇[1] 吴健[1] 毕擎[1] 

机构地区：[1]浙江省人民医院骨科,杭州310014

出　　处：《中华骨科杂志》1999年第6期353-355,共3页Chinese Journal of Orthopaedics

摘　　要：目的　报道1993 年1 月～1997 年10 月应用自体神经移植及骨骼肌包埋自体神经片段修复48 例60 条神经缺损,并根据不同神经,不同缺损长度、修复时间、缺损部位,比较二者间的疗效。方法　其中30 例38 条神经行神经移植,18 例22 条神经行骨骼肌包埋自体神经片段桥接。结果　术后随访12～28 个月,按MCRR 标准对肢体神经运动感觉功能评定疗效;优良率神经移植组2 ～5 cm占83 .3% ,6～10 cm 占76.9 % ,11 ～20 cm 占57 .1 % 。骨骼肌包埋自体神经片段桥接组2 ～5 cm 占80 % ,6～10 cm 占62.5 % ,11 ～20 cm 占50% 。神经移植组急诊修复为86.9 % ,3 个月内修复为77.7% ,3 个月后修复为50% ;骨骼肌包埋神经片段桥接组急诊修复为84.6 % ,3 个月内修复为80 % ,3 个月后修复为0 。神经移植组腕部80 % ,前臂为63 .6 % ,上臂为42 .8 % ;骨骼肌包埋神经片段桥接组,腕部75 % ,前臂55 .6 % ,上臂20 % 。结论　二者疗效比较,修复短距离或长距离缺损时差异无显著性意义(P > 0 .05),而中等距离缺损时疗效差异有显著性意义( P< 0 .05) 。急诊与3 个月内修复,二者优良率差异无显著性意义(P > 0 .05),3 个月后修复差异有显著性意义(P< 0 .05) ,在修复前臂与腕部神经缺损时二者疗效差异无显著性意义( P > 0.05) ,上臂神经缺损时?Objective To compare the results of using autogenous nerve graft embedded in skeletal muscle fibers with autogenous nerve graft in the treatment of peripheral nerve defects. Methods 38 nerve defects in 30 patients treated with autogenous nerve graft and 22 nerve defects in 18 patients with nerve fragment embedded in autogenous skeletal muscle fibers between 1993 and 1997 were reviewed. The duration of follow up ranged from 12 to 28 months. The MCRR criterion was used to evaluate movement and sense outcomes in both groups. Results The excellent and good rate in autogenous nerve graft group was 83.3%in 2-5 cm defect subgroup, 76.9%in 6-10 cm subgroup and 57.1%in 11-20 cm subgroup,compared with those of 80%in 2-5 cm defect subgroup, 62.5%in 6-10 cm subgroup and 50%in 11-20 cm subgroup in the combined nerve fragment graft group embedded in the skeletal muscel fibers. The excellent and good rate was 86.9%,77.7%and 50%for urgent repairing, delayed repairing within 3 months and delayed repairing above 3 months respectively by nerve grafting, contrasted to those of 84.6%, 80%and 0%by the combined nerve fragment grafting. The excellent and good rate for carpus, forearm and upper arm defects was 80%,63.6%and 42.8%respectively in nerve grafting group,but was 75%,55.6%and 20%in the combined nerve graft group. Conclusion The nerve graft group is superior to the combined nerve fragment graft group considering the length of defect, timing of repair and location of the defect.

关 键 词：神经移植 组织包埋 骨骼肌 自体移植 

分 类 号：R622.3[医药卫生—整形外科]