神经松解与神经移植手术治疗早期骨间背神经自发性卡压的效果评价  

Evaluation on effectiveness of neurolysis and nerve grafts surgery in treatment of early spontaneous posterior interosseous nerve entrapment

作　　者：王海涛[1] 郑文祯 杨小玉[2] 张巨[3] 马恩元[1] 

机构地区：[1]北华大学附属医院骨外科,吉林吉林132011 [2]吉林大学第二医院骨外科,吉林长春130041 [3]吉林大学中日联谊医院手外科,吉林长春130033

出　　处：《吉林大学学报（医学版）》2014年第6期1270-1274,1338,共6页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(30872609)

摘　　要：目的：探讨早期骨间背神经自发性卡压手术的治疗方法，观察术后疗效并评价其治疗效果，为临床选择合理手术方案提供依据。方法：对收治的21例早期骨间背神经自发性卡压患者进行手术治疗，13例、18臂行神经松解术，8例、8臂行神经移植手术，并行伸肌肌纤维病理学检查，术后随访10～20个月，评价患指伸指肌力及掌指关节活动度。结果：病变伸肌呈部分失神经改变；松解手术肌力中优14臂（82.35％），良2臂，可1臂，失访1例；伸指功能中优15臂（88.24％），良1臂，可1臂，失访1例；神经移植肌力中优6臂（75.00％），良1臂，可1臂；伸指功能中优7臂（87.50％），良0臂，可1臂，差0臂。结论：早期骨间背神经卡压患者伸肌呈部分失神经病理改变，卡压神经轻度变性时选择神经松解手术治疗，卡压神经发生重度变性时需行一期神经移植手术治疗，术后疗效满意。Objective To investigate the surgery method for early spontaneous posterior interosseous nerve entrapment,to observe the postoperative efficacy in treatment,to evaluate the surgical outcomes,and to provide a foundation for clinical choice of reasonable operation scheme.Methods 21 cases of early spontaneous posterior interosseous nerve entrapment received operation. 1 3 cases （1 8 arms） were treated by neurolysis, and 8 cases （8 arms ）were treated by nerve grafts with small vessels wrapping operation;all the patients were followed up for 10 to 20 months;the finger extensor muscle strength and metacarpophalangeal joint activity were evaluated. Results The lesion extensor muscles were part of the denervation changes.Neurolysis muscle strength：14 arms were excellent（82.35%）,2 arms were good,1 arm was fair,1 case was lost;extensor function：15 arms were excellent（88.24%）,1 arm was good,1 arm was fair,1 case was lost.Nerve graft muscle strength：6 arms were excellent（75.00%）,1 arm was good,1 arm was fair;extensor function：7 arms were excellent（87.50%）,0 arm was good,1 arm was fair.Conclusion Neurolysis can have a good efficacy in treatment of early spontaneous＆amp;nbsp;posterior interosseous nerve entrapment without obvious degeneration.When the severe degeneration of entrapment nerve happens,a nerve graft surgical treatment is needed.

关 键 词：骨间背神经 卡压 神经松解 神经移植 

分 类 号：R615[医药卫生—外科学]