周围神经侧侧吻合治疗痉挛性脑瘫初步报告

目的：用周围神经侧侧吻合术治疗肢体痉挛性脑瘫并探讨其机制。方法：对１６例肢体痉挛性脑瘫患者采用正常神经干与病变神经干的侧侧吻合术,即将支配痉挛肌群的主要神经干与相对正常的邻近神经干的近端显露出５～６ｃｍ后相互靠拢,切开两神经相邻面的神经外膜和束膜１～２ｃｍ,直至神经纤维裸露后相互紧密对合再吻合其束外膜。结果：经１０～３９个月（平均２４个月）的随访,所有患者的肢体痉挛、畸形均有明显的缓解,其中６例患     

大鼠神经端侧缝合的实验研究

目的：为进一步了解神经端侧缝合后再生的可能性。方法：用大鼠进行研究，实验分五组：Ａ组，将切断的腓神经远端与正常胫神经干行端侧缝合，保留缝合部胫神经外膜；Ｂ组，同Ａ组，缝合部胫神经外膜予以去除（“开窗”）；Ｃ组，将一神经移植段的两端分别与正常胫神经干和切断的腓神经远端神经干行“开窗”的端侧缝合；Ｄ组，将胫神经切断，近端与切断的腓神经远端神经干行“开窗”的端侧缝合。Ｅ组对照：仅切断腓神经。术后不同时期分别行电生理、组织学、神经纤维计数等检查。结果：鼠神经端侧缝合后腓神经远端有不同数量的有髓神经纤维再生。结论：动物鼠类神经端侧缝合能够再生     

神经端侧缝合再生的实验研究

目的：探讨神经端侧缝合术后神经的再生，为临床应用提供依据。方法：采用３０只大耳白兔，分６组。将右侧腓总神经切断，其远断端与胫神经行端侧缝合为实验组，切断远断端后不与胫神经缝合为对照组。术后进行电生理、组织学等观察。结果：可见胫神经侧支发芽长至腓总神经。结论：神经端侧缝合后侧支发芽支配与供神经无关的肌肉、皮肤     

采用神经纤维梳理技术显示神经端侧缝合后侧支再生的研究

目的探讨一种可直接显示神经端侧缝合后神经纤维侧支再生的方法。方法取5只成年Wistar大鼠，将右侧腓总神经切断，远端与外膜开窗的胫神经作端侧缝合。术后3个月切取缝合部位神经和对侧正常胫神经，福尔马林、锇酸和甘油处理后，于手术显微镜下剥离结缔组织，将神经纤维梳理出，并在光学显微镜下观察其形态。另切取缝合口及其远端的腓总神经作组织学检查。结果神经端侧缝合口分离出的神经纤维，可见在郎飞结附近发出细小侧芽，而正常胫神经则未发现。缝合口纵切片见神经纤维从胫神经进入腓总神经，缝合口远端腓总神经横切片见大量再生纤维。结论采用神经纤维梳理技术可直观地显示神经端侧缝合后神经纤维侧支再生的现象。     

神经束间侧侧缝合重建截瘫/四肢瘫感觉功能

目的：介绍一种重建截瘫／四肢瘫部分感觉功能的新方法。方法：选择具有感觉功能的神经干或束组作为供体神经,支配感觉消失区的神经干或束组为受体神经,在合适的平面将两神经的束外膜切开约1－1．5cm,相互紧密并扰后以9－10个“0”无损伤针线侧侧缝合束外膜,结果：21例（四肢瘫4例,截瘫17例）术后获1－5年（平均2年8个月）的随访,3例失访,受区感觉恢复达S3级者11例,S2级者6例,S1级者2例,但重建感觉区域的感觉定位均转换较差,结论：周围神经侧侧缝合可以重建截缝,四肢瘫患者的部分感觉功能。     

神经高位端端与低位端侧或侧侧缝合相结合提高神经修复能力的实验研究

目的对无缺损的周围神经高位损伤，提出高位端端与低位端侧或侧侧缝合相结合的新方法，观察神经再生和靶器官的恢复情况。方法SD大鼠80只，高位切断左侧胫神经。随机分为5组：A组：胫神经两断端行端端缝合，远端于膝关节水平与腓神经干行侧侧缝合。B组：断端处理同A组，远端移植正中神经作胫腓神经干之间的端侧桥接缝合。C组：单纯作断端的端端吻合。D组：胫神经干近端结扎并固定，远端与腓神经干行侧侧缝合。E组：近端处理同D组，远端切除部分神经段后，与腓神经干行端侧缝合。术后行肌电图检查及组织学观察并作统计学分析。结果术后早期（4周）D、E组有神经再生，术后12周A、B组的神经再生、传导功能及靶肌肉和运动终板的恢复情况均优于C、D、E组。结论高位端端与低位端侧或侧侧缝合相结合的方法，可尽早恢复对靶组织的营养和神经再支配，为高位缝合处高质量神经的长入赢得时间，提高了有效功能的恢复。     

周围神经侧侧缝合法的实验研究

目的 提出一种修复周围神经操作的新方法－－侧侧缝合法,并对侧侧缝合后神经的再生模式进行初步研究。方法 选用ＳＤ雄性大鼠１２只,双下肢随机分为实验侧和对照侧。实验侧：将腓总神经在大腿下１／３处切断,断端结扎后将其远端与相邻胫神经干适当松解后靠拢,纵行切开两神经相邻侧面的神经外膜、束膜长约０．５ｃｍ,至部分神经纤维外露。紧密对合两切开面后缝合束膜、外腊。对照侧：腓总神经在相同部位切除０．５ｃｍ,至部分     

经皮电刺激对端侧缝合后神经再生作用的研究

目的 研究经皮电刺激(transcutaneous electrical nerve stimulation,TENS)对周围神经端侧缝合后促神经再生的作用。方法 18只健康白兔按取材时间的不同随机分为A、B、C3组,白兔双侧腓总神经切断后与同侧外膜开窗的胫神经作端侧缝合。左后肢为实验侧,术后给予TENS,共用6周。右后肢不会电刺激,做为对照侧。分别于术后3、6、16周取材,进行大体观察、神经组织学、电生理、透射电镜和胫前肌肌湿重检查。结果 各组实验侧腓总神经有髓纤维数、运动神经传导速度、肌肉复合电位（CMAP）波幅和胫前肌肌湿重均高于对照侧（P＜0．05）。实验侧腌总神经髓鞘成熟程度优于对照侧。结论 TENS在提高神经端侧缝合后侧支萌出率和减轻失神经肌肉萎缩方面有积极的作用。     

神经干端侧吻合后侧支发芽能力的实验研究

为观测神经干在端侧吻合后的侧支发芽能力，分别在供体神经上作外膜开窗，检查其侧支发芽情况，并与端端吻合作比较。实验用１６只成年ＳＤ大白鼠，将其随机分为４个组。１组，腓神经切断后在胫神经外膜上开窗，然后将两者作端侧吻合。２组，手术步骤同１组，但不作胫神经外膜开窗。３组，胫神经不开窗，离断的腓神经与胫神经平行缝合。４组，腓神经切断后立即行端端吻合。术后３个月，所有动物分别测定腓神经功能指数（ＰＦＩ），乙酰胆碱转移酶（ＣｈＡＴ）活性，并作组织学检查。结果显示，第１组与第２组的ＰＦＩ，ＣｈＡＴ活性无明显差异（Ｐ＞０．０５）。组织学检查证实，侧支发芽纤维的存在，即使在第３组，也可见到大量的神经纤维，侧支发芽的纤维为小的有髓纤维。但１组的ＣｈＡＴ活性仅是第４组的２／３。结果提示，外膜鞘在远期对神经的侧支发芽能力几乎没有影响。神经侧支发芽能力比我们通常想象的要强，但在临床应用以前尚需作进一步研究。     

神经端侧缝合术后远期疗效的临床观察

目的 探讨周围神经断伤行端侧缝合术后的远期疗效。方法 对12例周围神经断伤作端侧缝合术。其中，前臂尺神经长段缺损3例，远断端与邻近正中神经干作端侧缝合；腓肠神经小腿中下段缺损7例，远断端与邻近腓浅神经干作端侧缝合；腓总神经膝上长段缺损2例，远断端与胫神经干在膝部作端侧缝合。对照组6例，皆为腓肠神经小腿中下段的缺损，远断端未作处理。术后连续随访3～5年。结果 缺损神经支配区感觉功能有所恢复，而运动功能恢复不明显。结论 神经端侧缝合后感觉功能有一定的恢复，运动功能恢复差，临床应谨慎选择使用。     

Repair and reconstruction of peripheral nerve injuries

Axonal regeneration after transection is a complex biological process. It is not merely a process of tissue repair, but rather of cellular repair of a large number of nerve cells. Regeneration involves restoration of the original morphology of each single cell, rather than proliferation. Techniques in microneurosurgical reconstruction of peripheral nerve injuries have improved over the last two decades, with subsequent improvement in functional results. Nerve autografts are now routinely used to guide the regrowth of the proximal nerves to distal nerve segments. However, the limited source of expendable cutaneous nerves restricts the use of nerve grafting techniques and is associated with significant morbidity. With extensive injuries there is an insufficient quantity of nerve autograft material to facilitate optimal repair. In future, the use of artificial conduits or nerve allografts could provide a limitless source of material to reconstruct otherwise irreparable traumatic nerve injuries. Establishment of appropriate strategies to suppress host-immune reaction or donor antigenicity would facilitate clinical allogeneic nerve transplantation. Guest lecture presented at the 69th Annual Meeting of the Japanese Orthopaedic Association in Tokyo on April 13, 1996.     

Repair of peripheral nerve defect with direct gradual lengthening of the proximal nerve stump in rats.

We investigated the effect of direct gradual lengthening on the proximal nerve stump and subsequent nerve regeneration in rats. A 10-mm-long nerve segment was resected from the sciatic nerve of each rat. The proximal nerve stump was directly lengthened at a rate of 1 mm/day using an original external nerve distraction device. Experiment I: After distraction periods of 10, 15, and 20 days, the length of each nerve was evaluated, and the lengthened nerve stump was also examined by immunohistochemical analysis. Experiment II: After a distraction period of 20 days, both nerve stumps were refreshed and direct end-to-end neurorrhaphy was performed. For control, 10-mm nerve grafting was immediately performed after nerve resection. Nerve regeneration was evaluated electrophysiologically and histologically 7, 9, and 15 weeks after nerve resection in both groups. The whole proximal nerve stump, including the endoneurium and the axon, could be lengthened in proportion to the distraction period. There were no significant differences in motor nerve conduction velocity and tetanic muscle contraction force between both groups. Histologically, the total number of myelinated fibers was significantly greater in the nerve lengthening group than in the autografting group. This study demonstrated that the whole proximal nerve stump including the endoneurium and the axon could be lengthened by direct gradual distraction, and that this method might have potential application in the repair of peripheral nerve defects.     

Comparison of assessment tools to score recovery of function after repair of traumatic lesions of the median nerve

In this paper the recovery after repair of the median nerve has been used to compare different assessment tools for evaluation of peripheral nerve function: touch (moving 2-point discrimination (2PD); Semmes-Weinstein (SW) monofilament, motor (Medical Research Council (MRC) scale), combined motor and sensory (Dellon modification of the Moberg pick up test; Moberg Recognition test), and pain (visual analogue scale; pinprick-test). The mean (SD) age of our 28 patients was 28 (12) years. The mean (SD) follow-up period was 5 years, 2 months (2 years, 8 months). On the operated side three patients (11%) had a moving 2PD of less than 4 mm. The results of the moving 2PD were compared with those of the SW monofilaments, but with a poor correlation. The MRC score correlated well with opposition movement of the thumb and muscle wasting (p<0.01). We recommend a number of tests to evaluate (the chronological return of) peripheral nerve function.     

Current concepts in diagnosis and management of common upper limb nerve injuries in children

Peripheral nerve injuries (PNI) of the upper limb are a common event in the paediatric population, following both fractures and soft tissues injuries. Open injuries should in theory be easier to identify and the repair of injured structures performed as soon as possible in order to obtain a satisfying outcome. Conversely, due to the reduced compliance of younger children during clinical assessment, the diagnosis of a closed nerve injury may sometimes be delayed. As the compliance of patients is influenced by pain, anxiety and stress, the execution of the clinical manoeuvres intended to identify a loss of motor function or sensibility, can be impaired. Although the majority of PNI are neuroapraxias resulting in spontaneous recovery, there are open questions regarding certain aspects of closed PNI, e.g. when to ask for electrophysiological exams, when and how long to wait for a spontaneous recovery and when a surgical approach becomes mandatory. The aim of the article is therefore to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.     

Indication,technique and results of facial nerve reconstruction

Summary 160 patients with various intraor extracranial pathologies were treated by microsurgical facial nerve reconstruction at Nordstadt Neurosurgical Clinic between 1978 and 1993. Facial nerve reconstruction was accomplished along the anatomical course of the facial nerve from its origin at the brainstem, within the mastoid, at the stylomastoid foramen and within the face. Mostly, reconstruction was indicated because of nerve discontinuity (n=61), whereas facial nerve reanimation with a donor nerve such as the contralateral facial nerve or the ipsilateral hypoglossal nerve was indicated in 99 cases of loss of a proximal nerve stump. Depending on the site of the lesion reinnervation started at 5 to 15 months postoperatively lasting for 2 to 3 years with overall satisfactory results. 69% of all the patients regained good symmetry on rest, complete eye closure equivalent to House-Brackmann-Score III: Patients with complete failures either suffered of non-related diseases such as cancer leading to death before the estimated time of recovery or were exposed to radiation or received facial nerve reconstruction after long-standing facial deficit and marked muscular atrophy. The indication of the adequate method depends on the clinical course with or without preexisting facial paresis, on considering the intraoperative state of the facial nerve, the identification and microsurgical preparation of adequate nerve stumps, as well as on the adaptation techniques and the postoperative guidance of the patient. We conclude that facial nerve reconstruction by transplantation at either site of the nerve course or by reanimation with a donor nerve are effective and reliable procedures of treatment leading to satisfactory functional and cosmetic results.     

Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique

A comprehensive analysis of 187 patients (78 median, 86 ulnar, and 23 radial nerve lesions) treated by an interfascicular autogenous nerve grafting technique is presented. After a follow-up of at least 18 months good motor recovery was achieved in 72% of median nerve lesions, 77% of ulnar nerve lesions, and 57% of radial nerve lesions. Good functional sensory recovery was found in 36% of median, 45% of ulnar, and 48% of radial nerve lesions. It appears by multivariate analysis that the results obtained generally were better in younger patients, in patients with a shorter preoperative delay, and in cases with a shorter transplant.     

Anatomie fonctionnelle du nerf trijumeau

The cranial nerve (CN) V is a mixed nerve that consists primarily of sensory neurons. It exits the brain on the lateral surface of the pons, entering the trigeminal ganglion within a few millimeters. Three major branches emerge from the trigeminal ganglion. The first division (V1, the ophthalmic nerve) exits the cranium through the superior orbital fissure, entering the orbit to innervate the globe and skin in the area above the eye and forehead. The second division (V2, the maxillary nerve) exits through a round hole, the foramen rotundum, into a space posterior to the orbit, the pterygopalatine fossa. It then re-enters a canal running inferior to the orbit, the infraorbital canal, and exits through a small hole, the infraorbital foramen, to innervate the skin below the eye and above the mouth. The third division (V3, the mandibular nerve) exits the cranium through an oval hole, the foramen ovale. The third division also has an additional motor component, which may run in a separate fascial compartment. Most fibers travel directly to their target tissues. Sensory axons innervate skin on the lateral side of the head, the tongue, and the mucosal wall of the oral cavity. Motor fibers innervate the muscles that are attached to the mandible. Some sensory axons enter in the mandible to innervate the teeth and emerge from the mental foramen to innervate the skin of the lower jaw.     

双神经卡压综合征

目的：研究双神经卡压征的病因及手术治疗方法。方法：分析了自１９８８年以来同时诊断为腕管综合征和肘管综合征２６例３４侧的临床资料。全部患者均作两处神经松解术，平均随访１７个月。疗效评定标准，根据术后症状、体征的改善程度分优、良、可和无效四级。结果：２５侧术后疗效优良，占７３．６％（２５／３４）。结论：双神经卡压征手术治疗效果较好。当双神经卡压同时合并颈部神经卡压时，建议优先考虑远端的神经减压。当远端神经减压后未能改善近端神经卡压症状时，才考虑近端神经减压