周围神经损伤的显微外科修复

目的：分析应用显微外科技术在修复外周神经损伤中影响其疗效的因素及措施。方法：应用显微外科技术修复周围神经损伤300例345条神经,手术方法包括神经外膜缝合术、外膜束膜缝合术、束膜缝合术、神经移植术和神经松解术。结果：术后随访6～72个月,平均优良率74．8％。结论：应用显微外科技术对损伤神经的精确对合和及早修复能够提高疗效。     

应用显微外科技术修复外周神经损伤

目的：分析应用显微外科技术在修复外周神经损伤中影响其疗效的因素及措施。方法：应用显微外科技术修复外周神经损伤105例120条神经，手术方法包括神经外膜缝合术、外膜束膜缝合术、神经移植术和神经松解术。结果：术后随访6-36个月，平均优良率78.7%。结论：应用显微外科技术对损伤神经的精确对合和及早修复能够提高疗效。     

外周神经损伤的显微外科修复

目的 分析应用显微外科技术修复外周神经损伤的临床疗效。方法 自1987～2001年，用显微外科技术修复周围神经损伤308例466条神经，方法包括神经外膜缝合术、神经束膜缝合术、神经松解术及神经移植术。结果 术后经6～72个月随访，根据BMRC感觉、运动评价标准，其中疗效为优者203条，良者177条，优良率达82．07％。伤后3个月内修复者的优良率为92．27％，优于6个月后修复者。结论 应用显微外科技术对外周神经损伤进行修复，神经断端的精确对合和及早修复可提高临床疗效。     

应用显微外科技术治疗外周神经损伤

目的 回顾分析应用显微外科技术在治疗外周神经损伤中的体会。方法 应用显微外科技术治疗外周神经损伤78例93条神经，手术方法包括神经外膜缝合、束膜缝合、电缆式神经移植和屈曲关节位神经外膜缝合。结果 术后随访7个月～8年，平均36个月，平均优良率84．6％。结论 应用显微外科技术在治疗外周神经损伤时如能保证神经的无张力缝合、神经精确对位和及早修复是可以取得较为满意疗效的。     

周围神经损伤的显微外科修复

目的：分析应用显微外科技术修复周围神经损伤的疗效。方法：从１９８８年３月至１９９５年６月，用显微外科技术修复周围神经损伤６８例共７８条神经，手术方法包括神经松解术、神经直接缝合术和神经移植术等。结果：经术后９个月～７年随访，优良率为８５．８９％。结论：临床资料证明：显微外科技术在神经损伤修复中有很大的优越性，能取得较满意的疗效。     

人为因素导致上肢外周神经损伤延迟修复的显微外科治疗

目的 探讨分析应用显微外科技术治疗人为因素所致上肢外周神经损伤延迟修复的原因及治疗体会。方法 应用显微外科技术治疗人为因素所致上肢外周神经损伤延迟修复27例29条神经，手术方法包括神经松解、屈曲腕(肘)关节位神经外膜缝合、束膜缝合及电缆式神经移植。结果 术后随访8个月．9年，平均37个月，平均优良率77．8％。结论 应用显微外科技术治疗人为因素所致上肢外周神经损伤延迟修复时，如能尽早治疗并做到神经对位精确、无张力缝合以及神经彻底松解，是可以取得较为满意疗效的。     

周围神经损伤的基因治疗

周围神经损伤在工作和生活中较为常见。它的治疗已有一百多年历史,经历了以下三个时期一神经外膜缝合期此期仅缝合神经外膜而未对神经束做对合处理,因此疗效欠佳。二神经束膜缝合期２０世纪７０年代显微外科技术应用于临床,使束膜缝合成为可能,并使周围神经损伤修复的疗效有较大提高。但由于吻合口瘢痕、卡压、功能束错误对合等原因,疗效仍不令人满意。如果神经缺损较长,还需另取供区的功能性神经行神经移植。三分子生物学修复期２０世纪８０年代随着分子生物学的发展,周围神经损伤的修复进入了细胞分子水平,在损伤反应、再生机制和…     

显微外科手术修复周围神经损伤65例

自１９８６年６月－１９９４年６月，应用显微外科技术修复周围神经扣作６５例共６８条神经，随访时间６个月－８年，优良率达８８．２％。对急诊创伤，应争取１期修复神经损伤；对闭合性损伤，观察时间宜在６周之内，应及早手术探查并作相应的手术；对神经外膜缝合及外膜与束膜联合缝合方法进行了比较，其疗效并无明显的差别。手术成功的关键在于严格显微外科无创伤操作技术及神经修复无张力的原则，注意神经缝合的质量，最大限度地     

显微外科花絮

显微外科花絮△应用显微外科技术修复周围神经损伤６０例黑龙江省齐齐哈尔市第二医院骨科夏振飞，杜兆元，董涛来稿：１９８９年１０月以来，我们应用显微外科技术，根据伤情及受伤位置和是否需要作神经移植，对７２例（７９条神经）分别采用外膜或外膜加束组膜缝合，经８...     

上肢神经损伤的显微外科修复与康复

目的探讨开放性上肢神经损伤的显微外科修复及康复的疗效。方法上肢神经损伤31例。应用显微外科技术进行外膜缝合、束膜缝合、外膜束膜缝合分别予以修复，并把康复理念贯穿应用于治疗全过程。结果术后全部病例经1年至6年随访，平均优良率为83．3％。结论显微外科技术和康复理念的结合应用，是上肢神经损伤治疗获得满意效果的重要步骤。     

上肢神经损伤的急诊显微外科修复

目的：报道１９８１～１９９５年，显微外科急诊择期修复上肢神经损伤１７２例２２２条神经的临床效果。方法：对其中７５例１０４条神经开放性损伤进行急诊清创及显微外科修复。结果：术后有５３例７２条神经得到３个月～８年的随访，按ＢＭＲＣ提出的综合评价肢体神经运动和感觉功能来评定疗效，优良率达８６．１％。结论：应用显微外科技术对上肢神经开放性损伤进行急诊一期修复是提高周围神经损伤修复优良率的有效方法。     

肱骨骨折合并上肢神经损伤的治疗

目的 总结肱有折合并上肢神经损伤的治疗方法和效果。方法 ３２例闭合性骨折,稳定型骨折行手法复位,石膏夹板外固定;不稳定型骨折行切开复位内固定,同时松解或吻合受损伤的神经。２３例开放性骨折及经８周以上观察神经功能未恢复的９例闭合性骨折,应用显微外科手术修复损伤的神经。结果 ４７例获随访,随访时间６个月－２年,骨折均愈合,按神经感觉和运动功能恢复情况综合评定疗效：优２３例,良１５例,可７例,差２例,优     

腕部尺神经损伤的显微修复

目的：探讨腕部尺神经损伤的治疗方法和疗效。方法：对62例腕部尺神经损伤，行神经外膜缝合34例，神经束膜缝合30例，结果：全部病例术后随访时间平均为2．5年，按顾玉东的单根神经功能研究标准评定，神经外膜缝合优良率为52．9％，神经束膜缝合优良率为83．3％，结论：腕部尺神经损伤后行神经束膜缝合疗效明显优于神经外膜缝合。     

神经外膜逆行剪开套接吻合周围神经损伤临床研究初步结果

目的提出一种新的周围神经损伤吻合的方法,期望提高神经吻合的质量,以加快神经功能的恢复.方法于神经的远侧断端神经外膜做一纵行切口,长度与神经的直径相同,将该段神经束切除,剥离的神经外膜将近端神经断端套入缝合.临床上应用9例,其中正中神经2例,尺神经3例,桡神经3例,腓总神经1例.结果本组随访时间6～14个月,平均8个月;优3例,良3例,可2例,差0例,优良率75%.结论神经外膜逆行剪开套接吻合断伤神经符合神经微环境,为神经再生提供再生室,是提高神经功能恢复的有效方法.     

The relationship between structural features of peripheral nerves and suture methods for nerve repair

Based on techniques for identifying and distinguishing motor, sensory, and mixed fasciculi in peripheral nerves, the authors propose guidelines for selecting suture methods for nerve repair. When many mixed fasciculi are known to exist at the nerve lesion, epineurial repair is preferable; fascicular (perineurial) repair is more suitable when pure motor and sensory fasciculi are clearly recognized. Generally, epineurial repair is indicated for more proximal injuries, with fascicular repair most appropriate for more distal sites. A greater ratio of epineurial connective tissue to intrafascicular nervous tissue implies an inclination toward fascicular repair.     

Techniques for primary nerve repair

This article reviews the anatomy of the peripheral nerve, the pathophysiology of nerve injury, and Wallerian degeneration. It reviews the factors for deciding on immediate or delayed primary nerve repair and discusses the concept of longitudinal excursion of peripheral nerves about joints and the techniques for achieving an appropriate tension-free repair. The techniques of primary nerve repair, epineurial repair, and group fascicular repair are reviewed along with techniques for matching fascicles intraoperatively.     

Fascicular tubulization: a comparison of experimental nerve repair techniques in the cat

Peripheral nerve repair remains one of the most difficult problems in hand surgery; the results of conventional epineurial and fascicular suture repair are a major limitation to the rehabilitation of the patient. The aim of this study was to evaluate a tubulization technique of nerve repair by wrapping a membrane of hypoantigenic collagen around the nerve at the fascicular level. Cat ulnar and median nerves were used as a multifascicular nerve model. Thirty-eight animals were studied. Ten animals were included in long-term studies comparing fascicular tubulization to either epineurial suture or fascicular suture nerve repair. Histologically, the tube repairs demonstrated improved organization at the repair site compared with either suture technique. Tube repair is not significantly different statistically by quantitative histological and physiological evaluation methods from epineurial suture or fascicular suture repairs. Further studies in more clinically applicable animal models are required before this technique can be considered as an alternative to present clinical nerve suture techniques.     

Peripheral nerve repair by means of a flexible biodegradable glass fibre wrap: a comparison with microsurgical epineurial repair.

In this study, a new technique for the repair of divided peripheral nerves using a flexible controlled-release glass wrap is described and its successful use is reported. Corglaes is a biodegradable and biocompatible glass which, when used as a solid glass tube form as a nerve conduit, allows nerve regeneration. It is now produced as a flexible, porous wrap (CRG-wrap). In this study, the CRG-wrap was used to repair divided median nerves in the upper forelimb of sheep. The wrap was secured in place around the divided nerve ends using fibrin glue or 6/0 polyglactin sutures. Microsurgical epineurial suturing was used to repair the same injury in another group. Twelve sheep were used in each group. A control group of sheep, on which no operations had been carried out, was also examined. The outcome of each repair was assessed at 7 months by measuring transcutaneous stimulated jitter (TSJ), maximum conduction velocity (CVmax), wet muscle mass and morphometric measurements. Testing was carried out on the limb that had been operated upon and the normal contralateral forelimb. The ratio of the measurements taken in the operated and the normal limb (the right and left forelimbs in the control group) was used when carrying out statistical analyses on the results. The mean and variance of the ratios of each of the measured variables in the three repair groups were similar suggesting that nerve regeneration had occurred to a similar degree in all the repair groups (analyses were carried out using one-way ANOVA and Scheffé's test, with statistical significance assumed at p<0.05). The repair of peripheral nerves using the CRG-wrap is easy to learn, quicker and cheaper than microsurgical epineurial suturing, and can be carried out by any surgeon with basic surgical skills. It was concluded that CRG-wrap is a useful alternative to microsurgical epineurial suturing for the repair of peripheral nerves.