双端侧神经吻合修复双侧指固有神经陈旧性损伤  

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

作　　者：江起庭 杨丽娜 江志伟[2] 

机构地区：[1]巢湖紫晨手外科医院手外科中心,238000 [2]南京军区南京总医院全军普外科研究所

出　　处：《中华骨科杂志》2012年第12期1161-1165,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨双端侧神经吻合修复双侧指固有神经陈旧性损伤的疗效。方法2000年11月至2009年10月收治双侧指固有神经陈旧性损伤患者40例，15例采用神经移植双端侧吻合手术，将损伤的指神经切除，对远、近端尺、桡侧指固有神经分别进行端-端吻合，形成远、近两条神经弓；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，分别于神经弓的尺侧、桡侧开窗式端侧吻合于指神经。13例采用神经移植单个端侧吻合，12例采用神经移植端-端吻合。结果31例获得随访，随访时间6～8个月。双端侧吻合组12例，指麻木、疼痛完全消失，指腹饱满，弹性好；感觉测定为S（4．21±1．97）级，高于其他两组；两点分辨觉（5．4±0．9）mm，小于其他两组。单个端侧吻合组10例，指麻木减轻，自发性疼痛消失，触痛减轻；感觉测定为S（1．57±0．72）级；两点分辨觉（7．2±1．2）mm。端-端吻合组9例，指麻木、疼痛均减轻；感觉测定为S（3．19±1．04）级；两点分辨觉（7．6±0．8）mm。后两组感觉On,0定与两点分辨觉的差异有统计学意义。结论神经移植双端侧吻合既加强了单个端侧吻合的作用，又同时具有端-端吻合的优势。治疗双侧指固有神经长段缺损有效，能够消除患指麻木、疼痛，恢复指腹的灵敏性。Objective To investigate effect of double end-to-side neuroanastomosis for bilateral ob- solete proper digital nerve injuries. Methods From November 2000 to October 2009, 40 patients with bilateral obsolete proper digital nerve injuries were admitted to our center. Fifteen patients underwent double end-to-side neuroanastomosis. 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 antebraehii 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. Thirteen patients underwent single end-to-side neuroanastomosis, while other 12 patients underwent end-to-end neuroanastomosis. Results Thirty one patients were successfully followed up for 6 to 8 months. In double end-to-side neuroanastomosis group, 12 patients were successfully followed up; anaesthesia and pain of the injured fingers disappeared completely; finger pulp was plump with good flexibility; the average result of sensation measurement was S（4.21 ±1.97）, which was significantly higher than those of the other 2 groups; the average result of two point discrimination was 5.4±0.9 mm which was significantly lower than those of the other 2 groups. In single end-to-side neuroanastomosis group, 10 patients were successfully followed up; anaesthesia relieved and spontaneous pain disappeared completely, but there was still tenderness; the average result of sensation measurement was S（1.57±0.72）; the average result of two point discrimination was 7.2±1.2 mm. In end-toend neuroanastomosis group, 9 patients were successfully followed up; anaesthesia and pain relieved; the average result of sensation measurement was S（3.19±1.04）; the average result of two point discrimination was 7.68±0.8 mm; there were significant differences in results of sensation measurement and two point discrimination between the latter two groups.

关 键 词：指损伤 修复外科手术 神经移位 

分 类 号：R658[医药卫生—外科学]