Pulmonary and biceps function after intercostal and phrenic nerve transfer for brachial plexus injuries

This pseudo-randomized study was performed to compare the pulmonary function and biceps recovery after intercostal (19 cases) and phrenic (17 cases) nerve transfer to the musculocutaneous nerve for brachial plexus injury patients with nerve root avulsions. Pulmonary function was assessed pre-operatively and postoperatively by measuring the forced vital capacity, forced expiratory volume in 1 second, vital capacity, and tidal volume. Motor recovery of biceps was serially recorded. Our results revealed that pulmonary function in the phrenic nerve transfer group was still significantly reduced 1 year after surgery. In the intercostal nerve transfer group, pulmonary function was normal after 3 months. Motor recovery of biceps in the intercostal nerve group was significantly earlier than that in phrenic nerve group. We conclude that pulmonary and biceps functions are better after intercostal nerve transfer than after phrenic nerve transfer in the short term at least.     

神经移位修复臂丛神经根性撕脱伤

１９８７年７月～１９９４年６月，对２１例臂丛神经根性撕脱伤采用神经移位修复。其中复合移位４组神经（膈神经、副神经、颈丛运动支、肋间神经）者１例，３组（膈神经、副神经、颈丛运动支）者６例，２组（膈神经、副神经）者９例，１组（膈神经或颈丛运动支或肋间神经）者５例。术中发现臂丛神经变异１例，对４例合并锁骨下动脉损伤者，在神经移位的同时进行血管修复，促进患肢的血液循环，有利于神经的康复。随访到１９例，随访时间为８个月～６年２个月，优良率达７３．７％。认为，神经移位术是修复神经根性撕裂伤的常规方法，合并血管损伤者也应同时修复，对促进神经功能恢复有利     

臂丛神经根性撕脱伤后神经根回植的实验研究

目的探讨臂丛神经根性撕脱伤后，神经根回植脊髓对前角运动神经元的挽救效应及作用机制，观察回植后神经根的生长情况。方法成年Wistar大鼠30只，随机分两组，每组15只。取两组大鼠左侧为正常对照侧，不作任何处理；右侧进行模型制备。进行C4-6右侧椎板减压，于椎管内硬膜外撕脱C5、6神经根。实验组将C5神经前根回植入脊髓前角，用11—0无创缝线缝合2针，后根旷置，C5神经根埋入周围肌肉；对照组将撕脱的C5、6神经根埋入肌肉。术后2、4、6、8及12周取材，C6脊髓HE染色，观察脊髓前角运动神经元的形态和数量的变化；C6神经根作硝酸银染色，观察神经纤维的再生情况。结果两组大鼠术后均表现为右上肢上干瘫痪，余肢体活动正常。对照组撕脱的神经根与周围肌肉粘连；实验组神经根植入脊髓处有较多瘢痕组织粘连，未见神经根从脊髓上脱落。各时间点HE染色显示，实验组运动神经元胞体萎缩，部分运动神经元水肿，尼氏体减少或消失；对照组神经细胞胞体缩小。术后各时间点对照组脊髓前角运动神经元成活率分别为60．9％±5．8％、42．3％±3．5％、30．6％±6．1％、27．5％±7．9％及20．4％±6．8％，实验组为67．1％±7．4％、56．3％土4．6％、48．7％±8．8％、44．2％±5．5％及42．5％±8，3％，差异有统计学意义（P〈0．01）。硝酸银染色显示，实验组C6神经根硝酸银染色显示前角运动神经元能通过轴突再生进入回植的神经根内；对照组显示为神经纤维的退变，有髓神经纤维数目减少。结论臂丛神经根性撕脱伤后前根回植脊髓后，能够明显减少前角运动神经元的变性死亡。神经根回植后，运动神经元能通过轴突再生进入回植的神经根内，并有新生的有髓神经纤维生长。     

Treatment of brachial plexus injury with modified contralateral C7 transfer

Objective: To study the curative effects of different surgical methods using a contralateral C₇ transfer technique for treatment of brachial plexus injury induced by root avulsion. Methods: Sixty‐four patients with brachial plexus injury due to root avulsion were divided into two groups: 30 patients were included in Group A and 34 in Group B. In Group A, the contralateral C₇ roots were partially transected and anastomosed to one end of an ulnar nerve graft which had been removed from the affected limb. The other end of the ulnar nerve was divided into two parts and anastomosed to the distal ends of the recipient median and radial nerves, respectively. In Group B, the whole of the contralateral C₇ roots was transected and anastomosed to one side of an ulnar nerve graft, the other side of which was anastomosed eight months later to the distal ends of the recipient median and radial nerves. All subjects were followed up and the outcomes assessed. Results: Neurological deficit and recovery time of the donor limb in group A were less than those in group B. The nerve transfer procedure to the affected limb was easily completed in group A with less morbidity, and the tension of the stoma in group A was less than that in group B. However, there was no statistical difference between group A and B in the recovery of motor function and results of electrophysiological testing of the affected side (P > 0.05). Conclusions: The method of partial C₇ root transfer results in equally good motor function as does transfer of the whole root, while occurrence of motor and sensory damage is less than that which occurs with transfer of the whole root.     

The diagnostic value of intraoperative measurement of choline acetyltransferase activity during brachial plexus surgery

We used the measurement of choline acetyltransferase (CAT) activity to distinguish between preganglionic and postganglionic injuries of the spinal roots during brachial plexus surgery. This study includes ten spinal roots in six patients with traumatic brachial plexus injuries. The results of CAT activity were compared with myelographic findings, the operative findings and the intraoperative evoked spinal cord potentials. The results of CAT activity and the operative findings were consistent in all roots. Whereas CAT activity in fascicles in preganglionic injured roots was below 500 cpm, it was above 2000 cpm in postganglionic injured roots. This study shows that intraoperative measurement of CAT activity can provide useful information on the site and severity of brachial plexus injuries and the assessment of the motor function status of the injured spinal root, both directly and quantitatively.     

臂丛各神经根切断后靶肌肉内代偿机制的实验研究

目的 通过研究臂丛神经各根切断后主要靶肌肉内运动终板形态学和功能学的变化过程,探索臂丛神经各根在靶肌肉内分布特点和切断后的代偿机制。方法 120只雄性SD大鼠,随机分成5组,每组24只。右侧建成臂丛神经各根的切断模型,左侧为正常对照组。术后第1、4、8、12周,用乙酰胆碱酯酶染色和单纤维肌电图等方法,检测各神经根主要靶肌肉内运动终板形态学和功能学变化过程。结果 颈5神经根和胸1神经根切断后,靶肌肉内出现无代偿特征的Jitter图形,Jitter均值明显低于正常对照侧;颈6、颈7和颈8神经根切断后,出现明显的代偿性Jitter改变,但只在颈7神经根切断后第1～4周Jitter均值逐渐增大,均明显高于对照组(P<0.05),第8～12后恢复正常;其余各神经根切断后Jitter均值明显低于对照组(P<0.05);臂丛神经各根切断后靶肌肉内的MCD分布图表明,仅在颈7神经根切断后会出现明显代偿变化。靶肌肉内运动终板面积逐渐扩大,乙酰胆碱酯酶染色逐渐变淡,直至消失的情况出现在颈5神经根和胸1神经根切断后;颈6神经根切断术后靶肌肉内运动终板变化与颈8神经根切断术后几乎一致,大部分运动终板消失,但仍有部分面积扩大,淡染的运动终板存在;颈7神经根切断术后第4～8周,在某些区域能发现少数异常的运动终板,到第12周后,运动终板的大小、形态和染色深浅全部恢复正常。结论 颈7、8神经根切断后靶肌肉内出现可能的代偿改变,颈6神经根切断后代偿变化极其有限,颈5、胸1神经根不具有代偿潜力。     

模拟产瘫和成人臂丛神经根性损伤发生垂腕垂指畸形的大鼠模型

目的 建立产瘫和成人臂丛神经根性损伤出现垂腕垂指畸形的大鼠模型.方法 取雄性SD大鼠48只,其中幼年组(生后7 d)和成年组(大于3月龄)各24只,每个年龄组大鼠按神经根处理方式等分成3个亚组,即切断右侧C5、6神经根组、切断C5、6、7神经根组和切断C5、6、7、8神经根组.术后3个月后行如下检测:各组大鼠垂腕垂指发生率;桡神经有髓神经纤维通过率;Western Blot检测桡神经组织内神经丝蛋白200(NF200)和外周髓鞘蛋白0(MPZ)的表达水平.结果 C5、6神经根切断后,各年龄组大鼠实验侧均无垂腕垂指畸形,桡神经有髓神经纤维的通过率较健侧均无明显降低,各组间差异无统计学意义(P＞0.05).各组桡神经组织内NF200和MPZ相对表达量差异均无统计学意义(P＞0.05).C5、6、7神经根切断后,幼年组垂腕垂指发生率均明显高于成年组(P＜0.05),桡神经有髓神经纤维通过率均低于成年组(P＜0.05).幼年组桡神经组织内NF200和MPZ相对表达量均低于成年组(P＜0.05).C5、6、7、8切断后,各年龄组大鼠每例实验侧均出现垂腕垂指畸形,各组实验侧桡神经有髓神经纤维通过率均明显降低,但无年龄差异(P＞0.05).各年龄组桡神经组织内NF200和MPZ相对表达量均降低,但差异无统计学意义(P＞0.05).结论 幼年及成年大鼠臂丛神经根性损伤造成垂腕垂指畸形的规律与人类相似,幼年大鼠C5、6、7神经根断裂即可导致垂腕垂指,而成年大鼠只有连续4个神经根(C5、6、7、8)断裂才会导致垂腕垂指畸形.因此大鼠是进行产瘫与成人臂丛神经根性损伤垂腕垂指畸形发生机制研究的理想动物.     

Free muscle transplantation combined with intercostal nerve crossing for reconstruction of elbow flexion and wrist extension in brachial plexus injuries.

Complete paralysis due to traumatic brachial plexus injury is extremely difficult to treat when the injury affects whole nerve roots and when motor function fails to show any signs of recovery. Seddon has suggested that arthrodesis of the shoulder and amputation at the humerus, combined with the use of a functional upper extremity prosthesis, was the most practical procedure available. Since 1965, in cases of irreparable lesions such as complete root avulsion type injuries, we have performed direct intercostal nerve crossing to the musculocutaneous nerve without free nerve graft to achieve elbow flexion. However, it is necessary to operate on the patient within 6 months following the injury to obtain good results. In the past there was no procedure for dealing with delayed cases of complete brachial plexus palsy. However, with the advent of microsurgical techniques, new approaches have become open to us. Since 1978, we have reconstructed the elbow flexor by the combined surgery of free muscle transplantation with intercostal nerve crossing in delayed cases of complete paralysis. This article introduces the operative technique and the results we have obtained.     

胸腔镜下切取膈神经移位重建全臂丛根性撕脱伤手部功能初步报告

目的探讨胸腔镜下膈神经超长切取、移位重建全臂丛根性撕脱伤手部功能的可行性。方法全臂丛根性撕脱伤3例,胸腔镜下于邻膈肌处切断膈神经,逆行游离胸腔内全长膈神经及其血管组织蒂,并由第二肋间引出,经胸大肌下移位至上臂上内侧,分别与尺神经前内侧部吻合2例,与移植股薄肌之闭孔神经前支吻合1例。结果2例膈神经联合第3～6肋间神经运动支移位修复尺神经者,结合短期免疫抑制剂FK506口服治疗,术后12个月手内肌肌电图检测均出现再生电位,1例随访15个月出现手内肌收缩。1例用以重建屈肘、屈指屈拇的移植股薄肌术后7月出现肌肉收缩,随访12个月肌力达M3。结论胸腔镜下全长切取膈神经,作为运动性动力神经移位应用于全臂丛根性撕脱伤的治疗,可在短时间内有效重建屈指屈拇功能,并有使手内肌神经再支配、开始恢复手内肌收缩功能的迹象。     

Surgical outcomes following nerve transfers in upper brachial plexus injuries

Background:

Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury.

Materials and Methods:

We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years) in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations), surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients), and phrenic nerve to suprascapular nerve (1 patient). In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients), intercostal nerves (2 patients), and phrenic nerve with nerve graft (2 patients). Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients), both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients), spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient), intercostal nerves (3rd, 4th and 5th) to musculocutaneous nerve (4 patients) and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient).

Results:

Motor and sensory recovery was assessed according to Medical Research Council (MRC) Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170 degrees). Eight patients scored M4 power in elbow flexion and assessed as excellent results. Good results (M3+) were obtained in seven patients. Five patients had fair results (M2+ to M3).     

健侧C7神经根移位对修复全臂丛根性撕脱伤术后运动皮层重塑的影响

目的 探讨大鼠全臂丛根性撕脱伤行健侧C7神经根移位术后运动皮层重塑的变化,比较不同术式对运动皮层重塑的影响.方法 建立幼年Sprague-Dawley大鼠左侧全臂丛根性撕脱伤模型90只,随机采用三种不同术式健侧C7神经根移位术治疗,包括健侧C7神经根移位至上干前股(A组,30只),移位至正中和肌皮神经(B组,30只)以及移位至正中神经(C组,30只).分别于术后1.5、3、6、9、12个月,以微电极刺激技术检测各组大鼠患肢支配区在双侧大脑运动皮层的分布.另取6只成年SD大鼠为空白对照组.结果 术后1.5个月,各实验组大鼠患肢支配区仅位于同侧运动皮层;术后3和6个月,患肢支配区均位于双侧运动皮层;术后9个月,A组大鼠患肢支配区已达对侧运动皮层;术后12个月,各实验组大鼠患肢支配区均位于对侧运动皮层,B组运动皮层重塑程度优于C组.结论 幼年大鼠健侧C7神经根移位术后运动皮层患肢支配区可实现由同侧皮层到双侧再到对侧皮层的跨大脑半球功能重翅.健侧C7神经根移位术受体神经的类型影响术后运动皮层重塑,移位至臂丛上干前股或同时移位至正中和肌皮神经更有利于实现运动皮层的跨半球重塑.     

椎管内外神经根移位整体化治疗臂丛神经根性撕脱伤的实验研究

目的：研究臂丛神经根性撕脱伤后,椎管内、外神经根移位治疗臂丛神经根性撕脱伤的疗效。方法随机选取SD大鼠60只,随机分为实验组及对照组。实验组采用椎管内C5,C6神经根原位修复及健侧C7神经移位修复C8,T1神经根治疗臂丛根性撕脱伤;对照组为膈神经修复肌皮神经,副神经修复肩胛上神经,健侧C7移位修复C8,T1神经根治疗臂丛根性撕脱伤。术后6个月时取材,进行电生理检测,肌肉湿重的测量,肌肉纤维横截面积的检测,HE染色检测观察肌纤维数量,电镜观察神经纤维数量及神经直径。结果实验组神经损伤修复6个月时,其肌肉湿重、肌肉纤维横截面积、肌肉运动诱发电位恢复率、神经生长情况优于对照组。结论椎管内神经根原位修复及椎管外神经根移位整体化治疗臂丛神经根性撕脱伤,无论从肌肉湿重、还是肌肉纤维横截面积比率,或者肌肉运动诱发电位及再生神经生长情况等方面,都取得了良好的效果。     

二期多组神经移位治疗臂丛神经根性撕脱伤的临床应用和疗效

目的 分析治疗臂丛神经根性撕脱伤的二期手术方法及其效果。方法 2001年8月～2003年4月8例全臂丛神经根性撕脱伤患者，年龄18～38岁。平均伤后6个月内，均应用以下术式治疗。手术步骤：一期手术，膈神经移位至臂丛上干前股，副神经移位至肩胛上神经；健侧C7神经移位至患侧尺神经；二期手术，第4、5、6、7肋间神经移位至桡神经和胸背神经，健侧C7神经经尺神经移位至正中神经。结果 术后8例均获随访，时间为二期术后l3～25个月，平均21个月。所有患者均有不同程度恢复，相应靶肌肉肌力恢复大于或等于M3为有效恢复，肌皮神经有效恢复6例，恢复率为75．0％；肩胛上神经有效恢复3例，恢复率为37．5％；桡神经有效恢复3例，恢复率为37．5％；胸背神经有效恢复6例，恢复率为75．0％；正中神经有效恢复5例，恢复率为62．5％。感觉恢复情况：正中神经感觉4例为S3，3例为S2，1例为S1。结论 二期多组神经移位安全有效，对部分早期臂丛神经损伤并要求缩短手术次数的患者，是一种可选择的方法。     

胸腔镜视下切取膈神经移位治疗臂丛神经损伤的临床应用报告

目的 首创在胸腔镜视下切断膈神经远端移接于肌皮神经的新术式。方法 临床应用５例。在胸腔镜视下于人膈肌近端切断膈神经,游离在胸腔内的膈神经全长。膈神经自锁骨上抽出经皮下引至肌皮神经３例,于锁骨下自第二肋间引起移位于肌皮神经２例。移接于肌皮神经主干２例,移接于肌皮神经肌支３例。首例于术后１１０ｄ,检测肱二头肥肥电图出现再生电位。结论 胸腔镜视下切并游离胸腔内膈神经全长,是膈神经移位术中切取膈神经的最佳     

改良式健侧颈7神经移位术治疗臂丛根性撕脱伤

目的研究探讨健侧颈7神经移位术不同术式及不同神经吻合方法的特点,并在一定程度上判断各方法对神经再生的影响及予后。方法本组64例臂丛神经根性撕脱伤的患者将其分成A,B两组。A组30例为实验组,将健侧颈7神经根部分切断,与患侧尺神经远端行部分端端吻合（尺神经自颈椎椎体前食管后穿过）;尺神经近端自然分成两束,分别与患侧正中神经、桡神经远端一期行端端吻合;B组34例为对照组,将健侧颈7神经根完全切断,与患侧尺神经远端行端端吻合（尺神经自颈前皮下穿过）,患侧尺神经近端于二期（术后8个月）与患侧正中神经或桡神经远端行端端吻合。术后定期观察随访并记录分析结果。结果术中神经吻合张力A组明显小于B组;术后健侧上肢短期感觉运动异常改变,A组较B组发生率低,且症状消失快,但电生理检查无显著差异（P〉0．05）。术后患肢功能恢复结果,A组较B组无显著差异（P〉0．05）。结论健侧颈7部分切开,术后减少了上肢感觉、运动异常的发生率,且症状消失快,同时吻合神经的直径相当,也减少了供区神经资源浪费;患侧尺神经自颈椎椎体前食管后穿过减少了神经吻合的张力;一期手术即可完成患侧上肢两条神经移植,患者痛苦小,病程短,费用低,易接受。因此A组改良的方法优于B组常规的方法。     

Anatomical feasibility of anastomosing intercostal nerves (D10&D11) and subcostal nerve (D12) to S2 ventral root and lumbar plexus for management of bladder function after spinal cord injury

ObjectiveThe transfer of peripheral nerves originating above the level of injured spinal cord into the nerves/roots below the injury is a promising approach. It facilitates the functional recovery in lower extremity, bladder/bowel and sexual function in paraplegics. We assessed anatomical feasibility of transfer of lower intercostal nerves to S2 ventral root in human cadaver for management of neurogenic bladder dysfunction in patients with spinal cord injury.MethodsStudy was performed in five formalin fixed cadavers. Cadavers were placed in prone position. A transverse incision was made along 11th ribs on both sides and 10th, 11th Intercostal nerves (ICN) and subcostal nerve were harvested up to maximum possible length. In four cadavers the ventral root of S2 was exposed by endoscope and in one by the standard open laminectomy. Intercostal nerves were brought down to lumbo-sacral region, S2 ventral root was cut cranially and feasibility of intercostal to S2 anastomosis was assessed.ResultsThe mean length of intercostal nerves was 18.4 cm for the 10th 19.5 cm for the 11th and 22.15 cm for the subcostal nerve. The length of harvested nerve and the nerve length necessary to perform sacral roots neurotization were possible in all cases by only by subcostal nerve while T11 and T10 ICN fall short of the required length.ConclusionFor Spinal cord lesions located at the conus, subcostal nerve could be connected to ventral root of S2 in an attempt to restore bladder function while 10th and 11th ICN had enough length to neurotize lumbar plexus.     

Nerve repairs for traumatic brachial plexus palsy with root avulsion

Thirty-six patients with traumatic brachial plexus lesions and root avulsions were treated surgically between 1972 and 1986 and were followed for more than 24 months (average, 42.6 months). Neurotization of the musculocutaneous nerve with intercostal nerves or the spinal accessory nerve resulted in satisfactory elbow flexion in 21 of the 33 cases (64%). Combined nerve repairs (i.e., intercostal and spinal accessory neurotization of the terminal branch of the brachial plexus in combination with nerve grafts from the upper spinal nerves of the brachial plexus) created a useful function in at least one functional level of the upper limb for 11 of the 15 cases so treated. Nerve repairs resulted in stability of the shoulder and elbow function controllable with a sensible hand for patients with root avulsion injury of the brachial plexus.     

正中神经损伤修复后大脑运动皮层可塑性变化的实验研究

目的 研究正中神经损伤修复后运动皮层可塑性的变化过程.方法 SD大鼠35只,分为对照组和手术组,手术组又分为术后1 d和1周、4周、8周、12周、16周,每组5只,左侧肢体为损伤修复侧,将正中神经在内侧束分支以远2.0 cm处切断后缝合.通过皮层内微电极刺激技术,定量评价正中神经损伤恢复过程中运动皮层的可塑性变化.结果 正中神经屈指屈腕区运动皮层面积[(0.85±0.1)mm2,-x±s,下同].术后1 d、1周,对侧皮层正中神经屈指屈腕区被桡神经、肌皮神经、腋神经位点占据,没有无反应位点出现;术后4周、8周和16周,运动皮层出现无反应位点;术后8周、12周,对侧皮层出现屈指屈腕位点,差异有统计学意义(P＜0.05);术后16周,与健康组相比,差异无统计学意义(P＞0.05),运动皮层内没有无反应位点出现.结论 成年大鼠正中神经损伤后其对侧运动皮层发生可塑性改变,是一个动态的过程,但其机制还需进一步的研究.     

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury

The purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the brachial plexus. We assessed 25 spinal roots in 19 patients. The results of the two investigations were consistent in all except two roots. Although assessment of ESCPs is easy and quick, it mainly records the nerve potentials along the sensory pathway. Although measurement of CAT activity needs a specimen of the nerve and the availability of a radioisotope laboratory, it gives direct information regarding the motor function of ventral spinal roots. These two techniques should be complementary to each other in order to achieve a more accurate diagnosis.     

闭孔神经移位修复腰骶丛神经根撕脱伤的解剖学观察及临床应用

目的 观察闭孔神经移位修复腰骶丛神经根撕脱伤的可行性及临床疗效.方法 取15具成人尸体标本,显露双侧闭孔神经及腰骶丛神经根.测量闭孔神经从主干起始部至闭孔入口处的长度及其在闭孔入口处的横径和纵径,计算横截面积,并在高倍显微镜下计数有髓神经纤维数目.以相同方法测量并计算股神经相应指标.2002年1月至2007年9月,共为5例腰骶丛损伤患者进行闭孔神经移位术.行健侧闭孔神经经椎体前腹膜后通路移位与患侧股神经直接吻合4例,闭孔神经移位与同侧S1神经根直接吻合1例.结果 闭孔神经的平均长度为(10.51±0.9)cm,横径(2.03±0.37)mm,纵径(2.78±0.29)mm,有髓神经纤维数目(5974±1996)根;股神经横径(3.79±0.58)mm,纵径(6.53±0.61)mm,有髓神经纤维数目(15 860±4350)根.术后3～7 d,所有患者供肢内收肌肌力均减弱至2～3级;术后3个月,4级2例,3级2例,2级1例(至术后1年时,内收肌肌力恢复3级).4例修复患侧股神经的患者,术后分别随访8个月～5年,股四头肌肌力4级2例,2级1例,1级1例;1例行闭孔神经移位与同侧S1神经根直接吻合的患者,术后11个月时小腿三头肌及屈趾肌肌力恢复至3级.结论 闭孔神经可作为一个安全有效的动力神经源,用其修复腰骶丛神经根撕脱伤可获得满意疗效.