螺旋式端侧编织缝合技术结合异体神经移植治疗创伤性神经瘤  

Surgical treatment of traumatic neuroma by helicoid end-to-side weaves neurorrhaphy technique with allogeneic nerve graft

作　　者：李俊杰[1] 何伟玲 竺枫[1] 祝斌[1] 王欣[1] Li Junjie;He Weiling;Zhu Feng;Zhu Bin;Wang Xin(Department of Hand Surgery,Ningbo Sixth Hospital,Ningbo 315042,China;Ningbo Bund Street Community Health Center,Ningbo 315020,China)

机构地区：[1]宁波市第六医院手外科,宁波315042 [2]宁波市外滩街道社区卫生中心,宁波315020

出　　处：《中华手外科杂志》2022年第5期394-398,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨螺旋式端侧编织缝合技术结合异体神经移植治疗创伤性神经瘤(taumatic neuroma,TN)的临床疗效。方法回顾性分析自2003年2月至2020年10月被确诊为TN且保守治疗效果不佳而接受手术治疗的患者8例。TN部位:前臂远端正中神经3例、腕部桡神经浅支1例、前臂远端尺神经2例、尺神经腕背支1例、指总神经1例。尺神经腕背支为医源性损伤,其余为局部挤压伤或者切割伤。手术过程:彻底松解神经后,取同种异体神经一条,两末端修剪成45°角斜面。在神经瘤及其两侧分别做神经束间分离,形成与神经主干呈45°角的隧道,将异体神经依次穿过各隧道,隧道口间断缝合固定,两神经末端分别与受体神经端侧缝合,缝合前切除受体神经对应面的神经外膜。统计手术前后患者视觉模拟评分(visual analogue scale,VAS)、两点分辨觉(two-point discrimination,2-PD)、握力及关节总活动度(range of motion,ROM)差异,并按Burchiel评级标准统计术后优良率。结果术后8例患者均获得随访,时间为8~37个月,平均21.8个月,按Burchiel评级标准:优良7例,差1例。VAS评分和2-PD分别由术前的(4.8±0.7)分、(8.9±1.8) mm降至术后的(1.8±1.4)分、(5.6±0.9) mm;握力由术前的(17.3±3.4) kg增加至(25.0±4.3) kg,术前术后差异均有统计学意义(P<0.01)。术前术后ROM差异无统计学意义(P>0.05)。结论使用螺旋式端侧编织缝合技术结合异体神经移植治疗TN,既可以保留已恢复的神经功能,又能通过多平面神经端侧接触促进受损神经功能恢复,近期疗效良好,尤其适用于已有部分神经功能恢复的患者。Objective To investigate the clinical efficacy of helicoid end-to-side weaves neurorrhaphy technique with allogeneic nerve graft in the treatment of traumatic neuroma(TN).Methods Eight patients who were diagnosed as traumatic neuroma from February 2003 to October 2020 were analyzed retrospectively.They were all accepted surgical treatment due to poor results of conservative treatment.The TN location was at median nerve at distal forearm in 3 cases,superficial branch of radial nerve at wrist in 1 case,ulnar nerve at distal forearm in 2 cases,dorsal branch of ulnar nerve in 1 case,and common digital nerve in 1 case.The dorsal branch of the ulnar nerve is an iatrogenic injury,and the rest were local crush or cutting injuries.Surgical procedure:after completely releasing the nerve,take an allogeneic nerve,and trim the two ends into a 45°angle slope.The nerve bundles were separated on the neuroma and its two sides to form a tunnel with a 45°angle to the nerve trunk.The allogeneic nerve was passed through each tunnel in turn,sutured and fixed intermittently.The ends of the two nerves were sutured with the end to side of the recipient nerve respectively.Before suturing,the epineurium on the corresponding surface of the recipient nerve was removed.The differences of visual analogue scale(VAS),two-point discrimination(2-PD),grip strength and total range of motion(ROM)of patients before and after operation were statistically analyzed,and the excellent and good rate after operation was counted according to Burchiel grade standard.Results All the 8 patients were follow-up for 8 to 37 months with an average of 21.8 months.According to Burchiel grade standard,7 cases were excellent and 1 case was poor.VAS score and 2-PD were decreased from preoperative(4.8±0.7)points and(8.9±1.8)mm to postoperative(1.8±1.4)points and(5.6±0.9)mm.The grip strength was increased from preoperative(17.3±3.4)kg to postoperative(25.0±4.3)kg.The difference was statistically significant before and after operation(P<0.01).There was no significan

关 键 词：创伤 神经瘤 端侧缝合 神经痛 

分 类 号：R739.4[医药卫生—肿瘤]