带感觉神经的静脉网动脉化皮瓣移植修复手指脱套伤

目的：报道带感觉神经的静脉网动脉化皮瓣修复单个手指脱套伤的效果。方法：在显微镜下清创找出伤者指断端的指动脉，指神经及指动脉吻合，２～３条浅静脉与指背静脉，在前臂掌侧设计相应的带３～５条浅静脉及皮神经的静脉皮瓣，顺行移植于伤肢皮肤缺损处，皮瓣内的皮神经与指神经缝合，２～３条浅静脉与指动脉吻合，２～３条浅静脉与指背静脉吻合。结果：６例７指皮肤脱套伤所植的皮瓣全部成活，伤指恢复良好的感觉，两点辩别觉５～１０ｍｍ。结论：此种皮瓣一次完成手指脱套伤皮肤及感觉缺损的修复，为临床提供了一种新的理想的修复方法。     

Facial nerve reconstruction in neurofibromatosis 2

Summary Between 1979 and 1989, 13 patients with neurofibromatosis 2 underwent reconstructions of the facial nerve after removal of bilateral acoustic or facial neurinomas. Seven patients received hypoglossal-facial nerve anastomosis, and five reveived sural nerve grafting in the cerebellopontine angle. End-to-end anastomosis and intracranial-intratemporal sural grafting were performed for one patient each, respectively. Re-innervation was seen in all cases. The results were good in 11 cases. Two patients presented with poor results due to development of neurinomas close to the site of the nerve reconstruction. The importance of reconstructive surgery in patients with neurofibromatosis is stressed. The problems regarding failure of re-innervation in some cases and difficulties in their management are discussed.     

不可逆桡神经损伤的手功能重建

目的评估不可逆桡神经损伤后肌腱移位重建伸腕、伸拇及伸指功能的效果。方法1987年1月～2005年2月，用Riordan肌腱移位术治疗不可逆桡神经损伤25例。其中桡神经主干损伤19例，桡神经深支损伤6例；均伴伸拇及伸指功能障碍，肌力0～1级，前臂肌萎缩。肌腱移位术距神经损伤或修复时间为4个月～8年。结果术后23例经3～60个月随访，根据陈德松等制定的桡神经损伤后肌腱移位术疗效判定标准，优10例，良9例，手功能恢复基本满意；可2例，差2例，其中1例为移位肌腱张力不足，3例为移位肌腱粘连所致。结论Riordan肌腱移位术可作为不可逆桡神经损伤功能重建的首选方法。     

Seeding nerve sutures with minced nerve-graft (MINE-G): a simple method to improve nerve regeneration in rats

Background: The aim of this study was to assess the effect of seeding the distal nerve suture with nerve fragments in rats.

Methods: On 20 rats, a 15?mm sciatic nerve defect was reconstructed with a nerve autograft. In the Study Group (10 rats), a minced 1?mm nerve segment was seeded around the nerve suture. In the Control Group (10 rats), a nerve graft alone was used. At 4 and 12 weeks, a walking track analysis with open field test (WTA), hystomorphometry (number of myelinated fibers (n), fiber density (FD) and fiber area (FA) and soleus and gastrocnemius muscle weight ratios (MWR) were evaluated. The Student t-test was used for statistical analysis.

Results: At 4 and 12 weeks the Study Group had a significantly higher n and FD (p?=?.043 and .033). The SMWR was significantly higher in the Study Group at 12 weeks (p?=?.0207).

Conclusions: Seeding the distal nerve suture with nerve fragments increases the number of myelinated fibers, the FD and the SMWR. The technique seems promising and deserves further investigation to clarify the mechanisms involved and its functional effects.     

Axillary nerve injury in young adults—An overlooked diagnosis? Early results of nerve reconstruction and nerve transfers

Abstract

An injury to the axillary nerve from a shoulder trauma can easily be overlooked. Spontaneous functional recovery may occur, but occasionally reconstructive surgery is required. The time frame for nerve reconstruction procedures is from a neurobiological view crucial for a good functional outcome. This study presents a group of operatively and non-operatively treated young adults with axillary nerve injuries caused by motorcycle accidents, where the diagnosis was set late. Ten young men (median age at trauma 13 years, range 9–24) with an axillary nerve injury were diagnosed by examination of shoulder function and electromyography (EMG). The patients had either a nerve reconstruction procedure or were treated conservatively and their recovery was monitored. The axillary nerve was explored and reconstructed at a median of 8 months (range 1–22 months) after trauma in 8/10 patients. Two patients were treated non-operatively. In 4/8 cases, a reconstruction with sural nerve graft was performed and in 1/8 case only exploration of the nerve was made (minor neuroma). In 3/8 cases a radial nerve branch transfer to the axillary nerve was chosen as the procedure. The shoulder was mobilised after 3 weeks with physiotherapy and the patients were monitored regularly. Functional recovery was observed in 9/10 cases (median follow up 11 months, range 7–64) with EMG signs of reinnervation in seven patients. Axillary nerve function should not be overlooked in young patients with a minor shoulder trauma. Nerve reconstruction can successfully recreate function.     

利用副神经吻合重建面神经功能的临床研究——附10例报告

目的：总结我院采用副神经与面神经吻合重建面神经功能的病例,分析临床疗效,为更好地开展面神经修复工作积累经验。方法：收集1998～2005年间采用副神经吻合重建面神经功能病例10例,进行回顾性研究,总结手术要点,分别在术后1月、6月按H-B面神经功能评价系统进行功能评价,以达到Ⅱ级以上作为功能恢复标准。结果：①手术后1月面神经功能恢复者3例（30%）,术后6月功能恢复者8例（80%）;②术后28天内局部合并放疗者3例,其中术后1月面神经功能恢复者1例（33.33%）,术后6月功能恢复者2例（66.66%）。结论：采用副神经与面神经端端吻合是一种有效的面神经功能重建方法。     

数字化解剖方法定位小腿穿支研究

目的 以螺旋CT数据三维重建小腿穿支,对比常规X线片,观测小腿穿支分布特点,为临床提供精确化的立体解剖信息以及为设计穿支皮瓣提供形态学基础.方法 对15具尸体行一次性全身动脉明胶-氧化铅混合液造影,先行X线摄片,应用图像分析软件Photoshop及Scion Image对各穿支体进行分割显示及测量,再行螺旋CT扫描并进一步应用MIMICS 10.01软件行三维重建.结果 小腿共有外径大于0.5 mm的穿支(27±4)支,平均外径(0.8±0.2) mm,平均浅筋膜段蒂长(37.3±18.6) mm,单穿支平均供血面积(49.5±25.5) cm2.数字化小腿穿支模型能够准确地反映穿支之间、穿支与源动脉之间的形态学结构和空间关系.结论 数字化小腿穿支可清晰地反映穿支的几何特征及局部细节,显示穿支的来源与分布特点,不失为研究人体小腿穿支的形态特点及术前设计穿支皮瓣的较好途径.     

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.     

Collagen Tube Conduits in Peripheral Nerve Repair: A Retrospective Analysis

A chart review was conducted of all patients receiving NeuraGen® conduits from 2002 to 2007 at Regions Hospital, a level I trauma center. Ninety-six patients underwent 126 repairs using NeuraGen® conduits, and 64 patients were seen in follow-up. Repairs were largely of upper extremity sensory nerves but six were repairs of nerves elsewhere in the body. There were no intra-operative complications, but there were two minor postoperative complications and one postoperative pulmonary embolus. Forty of 126 repairs were lost to follow-up. Twenty-six of 126 repairs had follow-up with quantitative testing of nerve recovery (2-point discrimination, Semmes–Weinstein, or EMG testing), with 35% reporting improvement and 31% going on to a revision operation. Sixty of 126 repairs had qualitative testing performed (subjective or objective reporting of sensation or motor function), with 45% reporting improvement and 5% going on to a revision operation. Patients who went on to revision surgery were more likely to have undergone quantitative evaluation of sensation. Overall, sensory recovery was in the 35–45% range in our experience. Our results indicate that NeuraGen® collagen conduits can be used safely throughout the body.     

阴茎海绵体神经重建术研究进展

阴茎海绵体神经损伤是导致勃起功能障碍(ED)的常见原因,海绵体神经重建修复有望恢复患者性功能。海绵体神经重建的方法有直接吻合、自体神经移植以及可降解生物材料的替代,目前应用于临床的只有自体腓肠神经移植。神经重建过程中,神经生长因子也起重要作用。本文就近年阴茎海绵体神经的重建方法作一综述。     

不含指神经的逆行指动脉皮瓣修复手指末端缺损

目的：探讨不含指神经的逆行指动脉岛状皮瓣在修复手指末端皮肤及软组织缺损的临床疗效。方法采用逆行指动脉岛状皮瓣修复手指末端皮肤及软组织缺损48例54指,其中不含指神经28指,带指神经26指,观察修复效果。结果本组54指皮瓣全部成活,无静脉回流障碍,供区创面一期愈合。术后随访6～18个月,皮瓣外形满意、质地柔软、弹性好,色泽与正常接近,皮瓣不臃肿能耐寒,伤指无疼痛,两点辨别觉达6～10 mm。两种术式供皮区外观、弹性、质地与正常指皮肤相似,但26指不含神经的逆行指动脉皮瓣供区两点辨别觉可达4～8 mm,平均5 mm,持物稳定,根据手功能评定试用标准综合评定,优18指,良9指,可1指,优良率达96%。结论不含指神经的逆行指动脉岛状皮瓣是修复手指末端皮肤及软组织缺损一种很好的手术方法,值得推广应用。     

Atasoy flap

Fingertip tissue loss is frequent. It often requires a reconstruction with a flap in case of exposure of the distal phalanx. We will present the technique of reconstruction by means of a local pedicle flap described by Atasoy. It is a local bipedicled flap harvested from the fingertip. The incision is triangular or volar without exceeding the palmar fold of the distal interphalangeal. Laterally, it is located 2 millimetres from the lateral nail folds. The flap is detached from the phalanx on its deep aspect. When the flap is released it can protrude from 5 to 7 millimetres. The flap covering the phalanx is then fixed by means of an intradermic needle and sutured laterally. The needle and the stitches are removed between the 2^nd and the 3^rd postoperative week. Physiotherapy will start the day following the surgery. There should be a relative abundance of remaining fingertip tissue so that it will be able to cover the phalanx; this technique is recommended in both the strictly transverse and dorsal oblique amputations. Among the most common undesired effects we have sensory changes, temporary pains in the fingertip pulp space and the palmar retraction of the flap if not properly fixed. However, this flap is still reliable and can be reproduced; it gives excellent cosmetic appearance if it is set correctly.