以颞中静脉为标记定位面神经额支

目的探讨除皱术中以颞中静脉为标记,定位面神经额支的方法,以预防损伤。方法对12具防腐成人头部标本和2具新鲜成人灌注头部标本,进行显微解剖,观察颞中静脉与面神经额支的位置关系。结果①额支位于颞浅筋膜深面和颞深筋膜浅层之间的组织内;颞中静脉位于颞深筋膜浅、深层之间的颞浅脂肪垫内。有颧颞中静脉和颧颞侧静脉两个分支,收集眶周深层的静脉血,回流到颞浅静脉。与上、下睑静脉、眼静脉、睑外侧静脉形成交通。另外,与颞深静脉吻合,并借此与翼静脉丛相通。②在耳屏点与额骨颧突的连线上,颞中静脉的交点,距耳屏点的平均距离是(18.2±2.3)mm。颞中静脉与最近额支的距离是(9.3±4.3)mm;最远额支的距离是(23.5±3.6)mm。结论在耳屏点与额骨颧突的连线上,距颞中静脉5.0~27.1mm的区域,是面神经额支所在的“危险区”。     

拇指撕脱离断伤再植术中两侧指固有神经的修复

目的介绍拇指撕脱离断伤再植术中修复拇指两侧指固有神经的方法。方法1999年8月-2009年4月,在12例拇指撕脱离断伤再植术中,采用食指桡侧指固有神经背侧支和桡神经浅支第2指蹼支移位的方法,修复拇指两侧指固有神经。结果12例拇指撕脱离断伤均再植成功,均获随访1～2年,平均16月。拇指两侧感觉均恢复良好,两点分辨觉小于10mm,平均约7mm,按照感觉功能评定标准为S4。结论拇指撕脱离断伤再植术中,应用食指桡侧指固有神经背侧支与桡神经浅支第2指蹼支移位,能恢复拇指指腹两侧良好感觉。     

Transfer of the accessory nerve to the suprascapular nerve in brachial plexus reconstruction

PURPOSE: Transfer of the accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with brachial plexus palsy. We propose dissecting both nerves via a distal oblique supraclavicular incision, which can be prolonged up to the scapular notch. The results of the transfer to the suprascapular nerve are compared with those of the combined repair of the suprascapular and axillary nerves. METHODS: Thirty men between the ages of 18 and 37 years with brachial plexus trauma had reparative surgery within 3 to 10 months of their injuries. In partial injuries with a normal triceps, a triceps motor branch transfer to the axillary nerve was performed. The suprascapular and accessory nerves were dissected via an oblique incision, extending from the point at which the plexus crosses the clavicle to the anterior border of the trapezius muscle. In 10 patients with fractures or dislocations of the clavicle, the trapezius muscle was partially elevated to expose the suprascapular nerve at the suprascapular notch. RESULTS: In all cases, transfer of the accessory to the suprascapular nerve was performed without the need for nerve grafts. A double lesion of the suprascapular nerve was identified in 1 patient with clavicular dislocation. In those with total palsy, the average improvement in range of abduction was 45 degrees , but none of the patients with total palsy recovered any active external rotation. Patients with upper-type injury recovered an average of 105 degrees of abduction and external rotation. If only patients with C5-C6 injuries were considered, the range of abduction and external rotation increased to 122 degrees and 118 degrees , respectively. CONCLUSIONS: Use of the accessory nerve for transfer to the suprascapular nerve ensured adequate return of shoulder function, especially when combined with a triceps motor branch transfer to the axillary nerve. The supraclavicular exposure proposed here for the suprascapular and accessory nerves is advantageous and can be extended easily to explore the suprascapular nerve at the scapular notch.     

End-to-side repair of thenar motor branch of median nerve to the ulnar nerve after excision of the median nerve neurofibroma

A 13-year-old male patient suffering for the past 5 years with a gradually swelling and occasionally painful volar side of right forearm, presented to our clinic without any trauma. An end-to-side nerve repair performed between the ulnar nerve and thenar motor branch, and second common digital nerve to the digital nerve of the first finger for mend the sensorial, digital, and motor impairments related to the median nerve associated plexiform neurofibroma that occured after the excision of the tumor.     

神经损伤(移位)时近侧分支保留对神经再生肌肉功能恢复影响的比较实验研究

目的探讨神经移位时保留神经干近侧分支对神经再生和肌肉功能恢复的影响.方法SD大鼠36只,随机分两组,实验组(分支保留组):在右侧副神经发出2个进入斜方肌肌支后3mm处,用特制的损伤钳,以相同挤压力度及相同时间将副神经夹成2mm的损伤段;对照组(分支切断组):副神经远侧段的处理与实验组相同,并将副神经近侧的两个分支切断.术后2、4、6周分别进行电生理、组织学和图像分析检测,比较近侧分支保留与否对神经再生、肌肉功能恢复的影响.结果神经干电位传导速度(NCV)恢复率、有髓神经纤维通过率、神经纤维轴突截面积恢复率的检测结果显示实验组恢复优于对照组,差异有统计学意义(P＜0.05).结论神经损伤(移位)时保留近侧分支有利于神经损伤修复(移位)术后神经再生和肌肉功能恢复.     

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.     

三种脱细胞神经修复大鼠坐骨神经缺损效果的比较

目的 比较三种去细胞神经支架修复大鼠坐骨神经缺损效果差异.方法 取大鼠坐骨神经39条,分别用甘油(A组)、叠氮钠(B组)、三硝基甲苯(C组)萃取,每组13条.观察萃取神经结构.用A、B、C三组神经支架修复1.5 cm长的SD大鼠坐骨神经缺损,另设自体神经移植组(D组)和空白对照组(E组),每组10只,术后12周比较五者的修复效果.结果 萃取后A组90%细胞、B、C100%细胞消失,纤维性支架结构A组95%完整;而B、C组仅30%.修复后小腿三头肌湿重、神经电生理A、B、C三组修复大鼠坐骨神经缺损效果相当(P＞0.05),与D、E组比较(P＜0.05)、差异有统计学意义.结论 甘油、叠氮钠、三硝基甲苯等萃取神经可较好地修复坐骨神经缺损,但甘油处理神经最为简单.     

内脏神经-体神经端侧吻合后神经再生方式的研究

目的 通过内脏神经-体神经端侧吻合建立人工体神经-内脏神经反射弧大鼠模型25只,荧光双标追踪技术研究神经再生方式.方法 在成活的21只模型鼠左侧盆神经节(MPG)内注射0.5μl荧光金(FG),腰4前根(L_4VR)的外周神经-坐骨神经注射1μl快蓝(FB)进行逆行神经追踪.应用组织化学方法 对吻合口远端的神经根(L6VR)进行甲苯胺蓝染色.结果 逆行追踪结果显示FG单标和FG-FB双标神经元主要分布于脊髓L_4左侧前角,FB单标神经元主要分布于脊髓L_3-L_6左侧前角.脊髓腰4节段每张切片上FG单标神经元、FB单标神经元、FG-FB双标神经元数目分别为(20.8±3.3)、(5.7±1.3)、(10.3±0.7).吻合口远端(L_6VR)再生的神经经甲苯胺蓝染色后可见轴突呈深蓝色.结论 逆行追踪结果证明内脏神经.体神经端侧吻合建立人工体神经.内脏神经反射弧后,体神经可以通过侧枝发芽的方式长入并替代内脏神经.     

Effects of nerve growth factor on acetylcholinesterase activity of the proximal stump of the transected sciatic nerve

28 rats were studied. They were divided into four groups of 7 rats of each: one-day control animals (Group A), sevenday control animals (Group B), one-day nerve growth factor (NGF)-treated animals (Group C) and seven-day NGF-treated animals (Group D). In all animals, the right sciatic nerve was explored and completely transected using microscissors under a microscope. In NGF-treated animals, NGF (0.1 mg/kg NGF) was injected subcutaneously. In control animals, there was a statistically significant decrease in AChE activity in the proximal stump of the transected sciatic nerve at 7-day measurements (p < 0.05). In the NGF-treated groups, mean AChE activity in the proximal stump of the transected sciatic nerve was decreased at the 7-day measurement. AChE activity difference between control and NGF-treated groups, measured on the 7th day, are statistically significant (p < 0.01). These results demonstrate the effect of NGF on the cholinergic system.     

复合神经动作电位与神经再生纤维数目之间的相关性研究

目的 研究大鼠正中神经切断缝合后神经再生期间,其复合神经动作电位( CNAP)与神经再生纤维数目之间的相关性.方法 大鼠上臂正中神经中段切断后,用6种不同型号的缝线进行缝合,切断缝合后2周和8周,进行CNAP检测,观察其参数变化,然后切取大鼠正中神经组织标本(正常、缝合口近端、缝合口远端),用半薄切片甲苯胺蓝染色、免疫组化、luxol fast blue染色三种形态学检测方法进行有髓神经纤维计数,用线性回归方法分析他们之间的相关性.结果 神经切断缝合术后2周和8周,再生神经记录的CNAP波幅与正常的CNAP相比,差异有统计学意义(P＜0.01).波幅面积(Area)也显著低于正常(P＜0.01).不同型号缝线的各组之间的正中神经有髓纤维再生恢复率之间的差异都有统计学意义(P＜0.05).线性回归分析,远端记录的CNAP波幅和有髓纤维的计数之间有线性关系,拟合的线性方程,即2周:y=250.859x+ 27.826;8周:y=265.584x+2721.462.结论 大鼠正中神经切断缝合后早期和成熟期,再生神经远端的CNAP波幅与相应的有髓纤维计数之间均有线性关系,线性方程斜率的相近,仅截距有明显差异,可以在神经损伤后再生早期或晚期,根据电生理CNAP的波幅,通过线性方程计算出损伤远端的有髓纤维计数,确定神经再生的轴索通畅率,定量评定损伤神经的功能.     

正中神经、尺神经部分束支移位术重建屈肘功能

目的 观察正中神经、尺神经部分束支移位术的临床疗效及手术前后供体神经功能的变化,分析影响手术疗效的因素。方法 应用正中神经、尺神经部分束支移接给肱二头肌肌支治疗臂丛神经上千型根性撕脱伤,重建屈肘功能。对施行手术的36例患者进行6个月至5年多的随访,根据肱二头肌肌力和肘关节主动活动范围,将患者术后恢复情况分为三级：优：肱二头肌肌力达4级以上,肘关节屈曲达90度以上;可：肱二头肌肌力达3级,肘关节屈曲达60～90度;差：肱二头肌肌力2级以下,肘关节屈曲60度以下。分析影响疗效的几种因素。结果 手术疗效显著,有效率(肱二头肌肌力3级以上)达94．4％,优良率(肱二头肌肌力4级以上)达63．9％。手术前后供体神经功能没有明显变化。影响手术疗效的主要因素有：损伤类型、损伤原因、手术距损伤的间隔时间、患者年龄、供体神经的选择及术后功能锻炼。准确判断患者的损伤类型,严格掌握手术适应证是手术成功的关键。结论 正中神经、尺神经部分束支移位术是治疗臂丛神经上千型根性撕脱伤的一种安全、可靠、有效的手术方法。     

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     

The vascularized saphenous nerve as cross-face nerve graft

Summary The vascular anatomy of the saphenous nerve was studied by cadaver preparation, Indian ink and micropaque injection. A constant vascularized nerve graft with a good pedicle and suitable length for a cross-face anastomosis was found. The vascularized saphenous nerve was used for the first time as a cross-face graft in 8 patients with facial palsy. The Tinel-sign was followed-up and a biopsy of the nerve graft at the time of the muscle transplantation was carried out to compare the morphological results of the vascularized nerve graft with two free sural nerve grafts which were used in two patients at the same time. The functional results are demonstrated.     

内脏神经-体神经端侧吻合后神经纤维再生研究

目的 观察大鼠内脏神经-体神经端侧吻合后神经纤维的再生.方法 24只成年SD大鼠随机分为实验组(n=12)和正常对照组(n=12),实验组大鼠通过内脏神经-体神经端侧吻合建立人工体神经-内脏神经反射弧6个月后,在吻合口近端和远端分别截取10 mm的供体神经(L4VR)和受体神经(L6VR),在L6VR延续的盆副交感神经(PPN)和阴部神经(PN)分别截取10 mm的神经.正常对照组大鼠分别取相应节段的L4VR、L6VR、PPN和PN神经.标本经石蜡包埋切片并行甲苯胺蓝染色,比较实验组和对照组大鼠L6VR、PPN、PN神经纤维数量.结果 实验组大鼠横断面可见新生的有髓神经纤维,L4VR、L6VR、PPN和PN的神经纤维数量分别为1602.2±75.7、1037.9±123.6、817.0 ±52.2、510.4±29.1,吻合口远近端神经纤维通过率为64.8%,实验组和对照组大鼠相应的L6VR、PPN、PN神经纤维数目比率分别为70.2%、68.9%和62.2%.结论 大鼠内脏神经-体神经端侧吻合后体神经能够长入并替代内脏神经.     

下颌舌骨神经与面神经吻合的应用解剖

目的　为确保面神经与下颌舌骨神经顺利吻合提供参考。方法　在 2 5具 (5 0例 )尸头上解剖观察了下颌舌骨神经在颌下的走行、分支及双侧分支吻合情况。结果　下颌舌骨神经从下齿槽神经分出后在下颌舌骨沟内至下颌骨下缘处为第一段。从下颌骨下缘向前行至第一次分支为第二段 ,其长度为 13.6 1± 3.0 9mm ,直径为 1.2 1± 0 .14mm。从第一次分支后分别至二腹肌前腹与下颌舌骨肌的各分支为第三段 ,其中至二腹肌前腹支长度为 13.0 7±2 .49mm ,直径为 1.0 3± 0 .12mm ,至下颌舌骨肌支长度为 11.2 1± 1.75mm ,直径为 1.0 4± 0 .11mm。两侧之间有吻合。结论　该神经易于暴露 ,走行及分支均较恒定。适合于进行神经吻合。