神经外膜小间隙缝合联合脱细胞基质周围神经修复膜包裹修复正中神经损伤的临床效果  

Clinical effect of small gap suture of epineurium combined with acellular matrix peripheral nerve repair membrane wrapping in repairing median nerve injury

作　　者：沈美华 杨伽捷 施晓健 秦超 施凯兵 沈灵杰 刘合飞 江起庭 Shen Meihua;Yang Jiajie;Shi Xiaojian;Qin Chao;Shi Kaibing;Shen Lingjie;Liu Hefei;Jiang Qiting(Department of Hand and Foot Surgery,Haimen District People's Hospital,Nantong 226100,China;Nanjing Jiangbei Hospital Hand and Foot Microsurgery,Nanjing 210048,China)

机构地区：[1]南通市海门区人民医院手足外科,南通226100 [2]南京江北医院手足显微外科,南京210048

出　　处：《中华解剖与临床杂志》2024年第4期262-268,共7页Chinese Journal of Anatomy and Clinics

基　　金：南通市科技项目(MS12021092);吴阶平医学基金会临床科研专项资助基金(320.6750.2021-04-17)。

摘　　要：目的探讨神经外膜小间隙缝合联合脱细胞基质周围神经修复膜包裹修复正中神经损伤的临床效果。方法前瞻性随机对照研究。纳入2021年4月—2022年10月南通市海门区人民医院腕掌侧开放性正中神经损伤患者62例,其中男42例、女20例,年龄18~65(47.6±10.9)岁,采用数字表法随机分为实验组(30例)和对照组(32例)。实验组在神经外膜小间隙缝合后,吻合部位以脱细胞基质周围神经修复膜包裹固定,对照组在神经外膜小间隙缝合后,吻合部位旷置。观察指标:(1)比较2组患者性别、年龄、致伤原因等基线资料,(2)比较2组伤口愈合情况,以及有无感染、排异反应等围手术期并发症,(3)术后3、6个月通过塞姆斯塞温斯坦单丝(SWM)测验、两点辨别觉(2PD)评估并比较2组患者正中神经感觉功能恢复情况,(4)术后3、6个月采用中华医学会手外科学会正中神经功能评定试用标准,评价并比较2组患者正中神经运动功能恢复情况,(5)术后3、6个月比较2组患者正中神经运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)。结果(1)2组患者性别、年龄、致伤原因等基线资料比较,差异均无统计学意义(P值均>0.05)。(2)2组患者手术均顺利完成,术后2周伤口愈合良好,均未出现炎症、感染等并发症情况。(3)实验组和对照组患者SWM、2PD术后3个月比较,差异均无统计学意义(P值均>0.05),术后6个月比较,实验组优于对照组,差异均有统计学意义(Z=-2.64、-2.43,P值均<0.05)。组内比较,2组术后6个月均优于术后3个月,差异均有统计学意义(Z_(SWM)=-4.36、-3.46,Z_(2PD)=-3.60、-2.65,P值均<0.05)。术后6个月正中神经感觉功能比较,实验组优良率为93.33%(28/30),对照组为68.75%(22/32),2组比较差异有统计学意义(χ^(2)=5.96,P=0.014)。(4)术后3个月2组患者正中神经运动功能比较,差异无统计学意义(P>0.05),术后6个月比较,实验组优于对照组,差异有统计学意�Objective This study aimed to investigate the clinical effects of the small gap suturing of the nerve outer membrane combined with the wrapping of the acellular matrix peripheral to the membrane of the nerve undergoing repair on the repair of median nerve injury.Methods Randomized controlled study.From April 2021 to October 2022,62 patients with open median nerve injury on the wrist and palmar side were included in this study.The patients included 42 males and 20 females aged 18−65(47.6±10.9)years old.They were divided into the experimental(30 cases)and control(32 cases)groups in accordance with the random number table method.In the experimental group,after the small gap of the nerve outer membrane was sutured,the membrane of the nerve undergoing repair was wrapped around the acellular matrix at the anastomotic site and fixed.In the control group,after the small gap of the nerve outer membrane was sutured,the anastomotic site was left open.Observation indicators were obtained through the(1)comparison of baseline data,such as gender,age,and cause of injury,between the two groups of patients;(2)comparison of perioperative complications,such as infection,healing,and rejection reactions,between the two groups of wounds;(3)evaluation comparison of the results of the SWM test and two-point discrimination(2PD)test and recovery of median nerve sensory function at 3 and 6 months after operation between the two groups;(4)comparison of the recovery of median nerve motor function in the two groups by using the trial standard for the evaluation of median nerve function of the Hand Surgery Society of the Chinese Medical Association at 3 and 6 months after surgery.(5)comparison of the median nerve motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)between the two groups at 3 and 6 months after surgery.Results(1)No significant differences in gender,age,cause of injury,and other general data were found between the two groups(all P values>0.05).(2)The operation was successfully performed for all pat

关 键 词：周围神经损伤 正中神经 神经修复膜 脱细胞基质 神经修复 

分 类 号：R651.3[医药卫生—外科学]