7)周围神经损伤的显微外科修复.doc

周围神经损伤的早期显微外科修复 邓红平 王之宇 林格生 方基石* [摘要]目的 为了探索周围神经损伤早期显微外科修复的临床效果及预后。方法 根据神经损伤的部位及程度应用不同的显微外科方法进行修复。具体方法有以下数种：神经探查、神经松解、神经外膜修补、神经外膜端端吻合、神经束膜端端吻合、神经移植、神经移位、神经植入等。结果 共修复周围神经118例12条166处，获随访72例12条98处，随访时间7个月~2年,平均14.3个月。运动功能恢复达M3以上的占31.82%，而感觉功能恢复达S3以上的占67.74%，X2检验P＜0.01。其中前臂内、外侧皮神经，股外侧皮神经，腓肠神经损伤修复后感觉恢复均达到了S3。28条指神经损伤修复后感觉恢复达S3以上的占82.14%。尺神经、腓总神经的运动功能恢复最差，无一例恢复；而桡神经及股神经的运动功能恢复最理想。结论 应用显微外科技术早期修复周围神经损伤效果良好，但应注意修复时机及方式。术前判断损伤神经的预后，让患者知情并配合治疗，对提高疗效、减少医患纠纷的发生有很大的帮助。 [关键词]四肢 神经 损伤 显微外科技术 Repairtion of injury of peripheral nervous with Microsurgery technique DENG Hong-ping, WANG Zhi-yu,LING Ge-shen,et al.Department of Orthopedics,The First People’s Hospital,Wuyi,Zhejiang 321200,China [Abstract]Objective To explore the clinical effect and prognosis of Repairtion of injury of peripheral nervous with microsurgery technique.Methods With different microsurgery operations to repair peripheral nervous injury on the basis of position and degree of injury of peripheral nervous.Concrete methods include nerve explore,neurolysis,epineural suture,interfascucular suture, nerve anastomosis, neural transplantation, nerve transposition,neurotization.Results 118 cases and 12 twigs and 166 places peripheral nervous injury were treated .72 cases and 12 twigs and 98 places were followed up for average 14.3 months (range 7-24months).The motor function recovery above M3 rate was 31.82%,the sensory function recovery above S3 rate was 67.74% (X2-test P0.01). The sensory function recovery above S3 rate was 100% at medial or lateral antebrachial cutaneous nerves,lateral fenoral cutaneous nerves and sural nerves,and 82.14% at 28 twigs digital nerves. The motor function recovery poorest at common peroneal nerve, recovery best at radial nerve and fenoral nerve. Conclusions Excellent clinical effect can be obtained with microsurgery operations to repair peripheral nervous injury. The key points to improve the postoperative results and reduce dispute of doctors and sufferers are presented as follows: