周围神经侧侧吻合治疗痉挛性脑瘫初步报告  

The Treatment of Cerebral Palsy by Side-to-side Perepheral Nerve Anastomosis

作　　者：张少成[1] 禹宝庆[1] 石志才[1] 修先伦[1] 赵永江 黄平[1] 姚一平 

机构地区：[1]第二军医大学长海医院骨科,上海200433

出　　处：《中国矫形外科杂志》2000年第11期1056-1058,共3页Orthopedic Journal of China

摘　　要：目的 :用周围神经侧侧吻合术治疗肢体痉挛性脑瘫并探讨其机制。方法 :对 16例肢体痉挛性脑瘫患者采用正常神经干与病变神经干的侧侧吻合术 ,即将支配痉挛肌群的主要神经干与相对正常的邻近神经干的近端显露出 5～ 6cm后相互靠拢 ,切开两神经相邻面的神经外膜和束膜 1～ 2cm ,直至神经纤维裸露后相互紧密对合再吻合其束外膜。结果 :经 10～ 39个月 (平均 2 4个月 )的随访 ,所有患者的肢体痉挛、畸形均有明显的缓解 ,其中 6例患儿已无明显的痉挛发作 ,恢复了患肢的主要功能 ,并随着时间的延长而继续改善。未发现供体神经功能明显障碍。结论 :周围神经侧侧吻合术是治疗肢体痉挛性脑瘫的有效方法之一 ,术后痉挛肌群可获得部分正常的神经支配从而改变大脑皮层定位。Objective: To discuss a new method and its mechanism for the treatment of cerebral palsy.Methods:16 cases with cerebral palsy were treated by side-to-side perepheral nerve anastomosis.The tonic nerve trunk was kept abreast of neighbor donor nerve at suitable segment.the eqineurium and fasciculi fascia of two neighboring area were cut 1 to 2cm to appear nerve fiber.so that the nerve fiber section in the normal nerve were tranferred to abnormal nerve distal end.The epineurium and fasciculi fascia of two neighboring nerve were then side-to-side sutured with 9-“0” or 10 “0” threads.Results:All patients get muscle tonic reduced and the extremities deformity were improved significantly after 10 to 39 months,mean 24 months,follow-up.Six of them remain no significant extremity spasm onset.and their main function of the extremities were recovered.No donor nerve function lose was found.Conclusion:Side-to-side neuroanastomosis is one of the effective method to treat cerebral palsy.The fact that the nerve of the tonic muscle receive partial normal nerve fiber may change the cerebal pallium localization.

关 键 词：周围神经 侧侧吻合 脑瘫 治疗 

分 类 号：R742.305[医药卫生—神经病学与精神病学]