复合他克莫司壳聚糖鞘管小间隙套接尺神经离断伤的疗效分析

目的 探讨使用复合他克莫司(FK506)壳聚糖鞘管小间隙套接治疗尺神经离断伤的临床效果.方法 2003年2月至2006年4月,选取前臂尺神经锐器切割离断伤患者35例,采用复合FK506壳聚糖鞘管套接神经远近端,保留神经断端5.0mm间距,并注意防止神经断面间的扭曲对位,间隙内注入生理盐水,鞘管远近端与神经各缝合3针固定.术后石膏制动4周.结果 31例患者经10个月至2年的随访,按中华医学会手外科学会上肢部分功能评定试用标准进行疗效评定,其中优26例(84%)、良4例(13%)、可1例(3%).结论 采用保留神经断端小间隙法复合FK506壳聚糖鞘管套接治疗尺神经损伤既可有效预防断端间的瘢痕组织侵入,又能较好地发挥神经趋化作用,有效促进神经的再生.

The application of FK506 chitosan chamber combined with small gap anastomosis technique for repair of ulnar nerve rupture: a report of 35 cases

Objective To report the clinical outcomes of repairing ulnar nerve rupture using FK506 chitosan chamber combined with small gap coaptation technique. Methods Thirty-five patients with ulnar nerve sharp cut injuries were treated with FK506 chitosan chamber combined with small gap coaptation technique from February 2003 to April 2006. The severed nerve ends were tucked in the tube leaving a 5.0 mm gap in between. Caution was used to avoid twisting and wrong alignment of the two nerve ends. The gap was filled with normal saline. The nerve was secured to the tube with 3 stitches at both ends. A plaster was applied for 4 weeks postoperatively to immobilize the limb. Results Thirty-one patients were followed up for 10 months to 2 years. The functional recovery was evaluated according to the criteria for upper limb functional assessment issued by the Chinese Medical Association Hand Surgery Society. The results were rated as excellent in 26 cases (84%), good in 4 cases (13%) and fair in 1 case (3%). Conclusion FK506 Chitosan chamber combined with small gap coaptation technique can effectively prevent the growth of scar tissue into the nerve gap and facilitate chemotactic axonal growth. It is beneficial for nerve regeneration.