前臂外侧皮神经营养皮瓣修复手掌部软组织缺损22例观察

目的观察采用前臂外侧皮神经营养逆行岛状皮瓣修复手掌部软组织缺损的疗效。方法对2001-06～2009-01 22例手掌部软组织缺损患者经急诊清创后换药至创面条件好转后采用前臂外侧皮神经营养皮瓣逆行移植修复创面,供区游离植皮。结果术后皮瓣及供区均成活,随访7～24个月,手部色泽正常,恢复保护性感觉。结论前臂外侧皮神经营养逆行皮瓣方法简单,效果可靠,不损伤前臂主要动脉,能恢复手掌部保护性感觉,是修复手部创面的理想方法。     

臂丛神经损伤的显微外科治疗(附73例报告)

对 73例臂丛神经损伤患者采用显微外科治疗 ,包括直接外膜缝合、多组束膜缝合 ,膈神经、副神经、肋间神经、健侧C7神经根移位带血管尺神经移植桥接修复 ,小隐静脉动脉化隐神经移植 ,游离神经移植修复等方法。结果 :术后 5 0例随访 14年 ,9例随访 <1年。其中 41例有不同程度的肌力恢复 ,臂丛根性撕脱伤的神经移位治疗效果尚可。本组功能恢复较满意 ,其中 49例行支配肩关节外展的神经移位修复 ,外展功能恢复 >3 0°者 2 0例 ( 40 .8% )。 5 8例行支配肘关节屈肘的神经移位修复 ,屈肘恢复的有效率者 3 7例 ( 63 .8% )。 14例行支配屈腕指功能的神经修复 ,屈腕指活动恢复者 5例 ( 3 5 .8% )。 48例上肢感觉有恢复者 41例 ( 85 .4% )。其中 1例刀砍伤全臂丛离断患者上肢肌力恢复至肌力 5级 (M5)。认为显微手术方法治疗臂丛神经损伤可获得满意效果     

游离皮瓣移植对口腔颌面部恶性肿瘤切除术后组织缺损的修复效果观察

目的观察采用游离组织皮瓣移植对口腔颌面恶性肿瘤切除术后组织缺损的修复效果。方法对32例口腔颌面肿瘤切除术后的遗留创面采用游离组织皮瓣移植修补治疗。选取前臂皮瓣17例、股前皮瓣7例、腓骨皮瓣6例、背阔肌皮瓣2例。结果31例皮瓣移植成功,成功率为96．9％。术后发生血管危象2例,其中1例给予血管按摩并适当固定后危象解除,皮瓣恢复良好,另例抢救无效移植失败;发生感染2例、血肿1例,分别给予抗感染治疗及血肿清创止血处理后恢复良好。随访6～12个月,面部外观满意。结论采用游离组织皮瓣移植修复治疗口腔颌面恶性肿瘤术后组织缺损效果好、并发症少。     

隐神经及腓肠神经营养血管逆行皮瓣修复小腿远端和足踝部组织缺损

目的观察应用下肢两条皮神经营养血管皮瓣修复小腿远端和足踝部组织缺损创面的临床疗效。方法小腿远端及足踝部创面根据转移角度及距离灵活选择隐神经或腓肠神经营养血管皮瓣转移修复,术前先行多普勒检查明确穿支所在位置,根据神经走行设定皮瓣轴线,于深筋膜深面分离形成皮瓣,将隐神经或腓肠神经及伴行血管网包含于皮瓣内,转移修复创面,供区直接缝合或取皮植皮修复。结果 3年共应用该皮瓣修复下肢下段及足踝部缺损38例,完全成活33例,其余5例存在不同程度皮瓣远端坏死,2例经换药自愈,3例经清创植皮修复。结论隐神经及腓肠神经营养血管逆行皮瓣血供确切,解剖简单,完全能胜任小腿远端和足踝部组织缺损修复需要,适合基层医院开展。     

人工真皮联合自体薄层皮片移植修复难愈性创面的疗效观察

目的：观察人工真皮联合自体薄层皮片移植（简称复合皮移植）修复难愈性创面的疗效。方法选取住院的各种难愈性创面患者30例,均存在各种原因导致的不同程度和部位皮肤软组织缺损创面,部分病例伴有肌肉、肌腱、骨外露。一期清创后移植人工真皮,2～3周后局部肉芽组织生长良好,外露肌腱和骨组织被类真皮组织覆盖,二期移植自体薄层皮片。观察人工真皮和自体薄层皮片（复合皮）移植成活率、瘢痕增生、色素沉着和关节活动度等情况,综合评价人工真皮联合自体薄层皮片移植修复难愈性创面的临床效果。结果30例患者人工真皮移植后成活25例,成活率为83.3％;5例溶解失活,原因为局部感染4例,局部固定不良1例。存活的25例人工真皮联合自体薄层皮片移植成活率达100.0％。25例出院后均随访2～6个月,复合皮生长良好,光滑有弹性,无明显瘢痕增生,少量皮肤色泽改变;供皮部位恢复良好,无瘢痕增生,部分患者有少量色素改变。结论人工真皮联合自体薄层皮片移植修复难愈性创面,复合皮移植成活率高,创面愈合质量好,成活后的复合皮部位和供皮区瘢痕增生轻微,关节功能恢复良好,方法简便,为难愈性创面的修复提供了新选择。     

皮瓣修复足部软组织缺损25例体会

足部创伤引起足部软组织缺损后常导致骨及肌腱外露，通常需应用皮瓣修复创面。2001～2003年我们分别采用带隐神经营养血管、带腓肠神经营养血管、带血管蒂小腿内侧皮瓣及游离胸脐皮瓣对25例足部创伤患者行足部软组织缺损修复，取得了满意的效果。     

自体神经移植修复神经缺损的术后护理

目的探讨自体神经移植修复神经缺损的术后护理及康复。方法我院对41例周围神经缺损患者进行了自体神经移植,术后及出院后专项护理,术后6个月以上随访患者24例,对结果进行统计学分析。结果24例患者中,18例患者周围神经缺损修复效果达到优良,优良率为70．8％。结论对自体神经移植修复神经缺损的患者进行术后护理及康复。能达到很好的临床效果。     

游离皮瓣移植修复肢体软组织缺损(附59例报告)

对 5 9例严重肢体软组织缺损伤患者 ,取自体组织皮瓣游离移植修复肢体缺损。根据不同缺损与缺损的范围应用不同的游离皮瓣。皮瓣面积最小 10 cm× 12 cm,最大 2 0 cm× 40 cm。其中背阔肌皮瓣 43例 ,股前外侧皮瓣 7例 ,侧胸皮瓣 6例 ,脐胸皮瓣 3例。结果 :完全成活 5 6例。因受区创面不新鲜感染 ,2例部分坏死 ,1例完全坏死。认为用游离自体皮瓣移植修复严重的肢体软组织缺损 ,可有效修复肢体创面 ,防止因皮肤缺损所致血管、神经和骨骼的进一步损伤或感染 ,提高伤肢修复的疗效和功能     

骨骼肌桥接修复上肢神经损伤

1988～1992年,我们应用带血循环的骨骼肌桥接修复上肢神经损伤4例(8条),取得较好效果。本组平均年龄33岁。损伤神经为桡、正中、尺、肌皮神经各1条,桡神经肌支及皮支各2条。神经缺损长度为3～10cm。致伤原因为挤压撕裂伤3例,重物砸伤1例,皆在急症条件下行肌桥-神经桥接术。 1.手术方法及疗效:于缺损神经附近取健康带血循环的自体骨骼肌肌束1条,其直径比桥接神经直径稍大一些,长度比神经损伤缺损部分长1cm,选 8-0无创尼龙缝线行神经鞘膜与肌束对端吻合。肌蒂供应肌束血运,肌束两断端呈游离状态,与神经相吻合时各缝接8针。     

应用VSD技术和腓肠神经皮瓣逆行转移治疗严重的足踝部损伤

选择50例严重足外伤骨外露患者,对感染皮肤缺损先行清创及封闭负压引流（VSD）治疗1—3个疗程,后期应用腓肠神经营养皮瓣逆行移位修复足部的皮肤缺损骨外露,并且术中对小隐静脉和腓肠神经进行处理。结果发现,经VSD治疗后,患者感染均得到控制,骨外露创面有部分肉芽生长,其余创面肉芽组织生长新鲜,触之易出血,行细菌培养均阴性。行腓肠神经营养血管皮瓣移位后,1例皮瓣远端1／4坏死伤口感染外,其余均无感染发生,皮瓣均成活,恢复大部分感觉。认为封闭负压吸引可以控制感染、免除换药、刺激肉芽组织生长,为腓肠神经皮瓣移植提供良好的条件。腓肠神经皮瓣能为足部皮肤缺损提供很好的覆盖和足部耐磨功能恢复。     

糖尿病332例神经传导速度检测分析

对３３２例糖尿病患者肢体神经传导速度（ＮＣＶ）检测结果及临床情况进行回顾性分析。结果显示：Ⅰ型糖尿病４８例中，ＮＣＶ异常率为７７．１％，略高于Ⅱ型糖尿病２８４例中的６６．２％，总异常率为６７．８％。Ⅱ型糖悄病者病程〉５年组的ＮＣＶ阳性率（７４．５％）高于≤５年组。３３２例共检测神经２５４６条，其中运动神经传导速度（ＭＣＶ）检测异常率（３７．０％）和感觉神经传导速度（ＮＣＶ）经（３５．２％）相似。各     

转NCF基因3T3细胞在大鼠坐骨神经缺损中的修复作用

目的 了解微囊化转神经生长因子（NGF）基因3T3细胞在修复周围神经缺损中的作用。方法 异体静脉桥接神经缺损，形成神经再生室，其内填充微囊化转NGF基因3T3细胞，修复大鼠的坐骨神经10mm失。用微囊化3T3细胞作为对照组。术后12w ，进行辣根过氧化物酶（HRP）示踪实验。结果 术后12w，实验动物均未出现明显炎症及排斥反应。实验组脊髓灰质前角被HRP标记的阳性神经元数明显多于对照组，其差异具有显著性意义（P〈O.05）。结论 聚赖氨酸／海藻酸钠（APA）微胶囊与周围神经组织有良好的生物相容性；辅加转NGF基因3T3细胞对修复缺损的神经具有良好的桥梁作用和促神经生长作用。     

髋臼骨折并坐骨神经损伤的治疗(附54例分析)

目的 回顾性分析54例髋臼骨折合并坐骨神经损伤的治疗方法及疗效。方法 39例行手术治疗．将骨折复位、重建，钢板螺钉固定，坐骨神经探查，神经松解减压或束膜吻合；15例行保守治疗，给予患肢牵引，神经营养药物。理疗等。结果 髋臼骨折复位情况按Matta标准，手术组解剖复位为25例，满意复位为14例，不满意复位0例；保守组解剖复位3例，满意复位8例，不满意复位4例。获得随访46例，手术组34例，保守治疗组12例，随访12个月至8年，平均2年。坐骨神经损伤功能恢复情况根据英国医学研究院神经外科学会制定的神经功能评定标准(MCRR标准)，手术治疗组优19例，良10例，一般4例，差1例；保守治疗组，优5例，良2例，一般3例，差2例。结论 髋臼骨折合并坐骨神经损伤应早期手术，将骨折复位、固定，行坐骨神经探查，神经松解减压或束膜吻合术，可获较好疗效。     

Ultrasound-guided genicular nerve block versus alcoholic neurolysis for treatment of advanced knee osteoarthritis patients

Aim of the workTo investigate the clinical efficacy of ultrasound (US)-guided genicular nerve block (GNB) with adjuvant corticosteroid versus alcoholic neurolysis on pain and function of knee osteoarthritis (KOA) patients.Patients and methodsThis study involved 46 advanced KOA patients divided into two groups; group 1 was treated with US-guided GNB with 1 ml triamcinolone + 6 ml bupivacaine divided into the superior medial (SM), superior lateral (SL) and inferior medial (IM) genicular nerves and group 2 was treated with US-guided genicular nerve ablation with 0.5–0.75 ml solution containing 50% alcohol in 0.25% bupivacaine for each nerve. Patients were assessed before and after 1 and 6 months from the injection using visual analogue scale (VAS), numerical rating scale (NRS) for knee pain on walking and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score.ResultsPatients mean age was 57.15 ± 3.74 years, disease duration 9.5 ± 1.81, body mass index (BMI) was 35.46 ± 4.44 and were 27 females and 19 males (F:M 1.4:1). The age, disease duration, BMI and gender distribution were comparable between the two groups. VAS, NRS and WOMAC scores improved significantly after injection in group 2 up to 6 months while in group 1 improved for only 1 month. Adverse effects did not persist beyond two weeks and included local pain, hypoesthesia, swelling and bruise.ConclusionsGenicular nerve ablation with alcohol offers a new and seemingly safe modality to treat KOA and improves pain intensity and physical functioning with less cost, less logistic support and avoiding possible corticosteroids adverse effects.     

Effect of platelet-rich plasma on reconstruction with nerve autografts

Despite advances in understanding of peripheral nerve injuries and regeneration and advances in surgical techniques, successful outcomes cannot be guaranteed after reconstructive surgery. Platelet-rich plasma (PRP) has been reported to have positive effects on nerve regeneration, as well as on tissue healing. The present study was designed to evaluate the effect of PRP on nerve-grafted defects. Sprague–Dawley rats were divided into four surgery groups (n = 7 in each). A 1-cm long nerve defect was created in the upper thigh and then reconstructed using a nerve autograft in all groups. The wet muscle weights, electromyographic findings, and histomorphologic changes were evaluated 10 weeks later. As shown by both the electromyographic (p < 0.001) and histomorphologic findings (p < 0.001), PRP had more positive effects on nerve gap reconstruction in Group 3 then Group 4 as compared to the control groups. The present study is novel in that it evaluated the regeneration effect of PRP on a large nerve defect reconstructed with a nerve graft rather than primary repair. The results are encouraging for further experimental studies on the role of PRP in nerve healing.     

Cross-sectional area reference values for high-resolution ultrasonography of the upper extremity nerves in healthy Asian adults

In this study, multiple-site, cross-sectional area (CSA) reference values were established for major peripheral nerves, including small branches, in the upper extremity of a healthy Asian population.This study included 107 prospectively recruited age-matched, healthy subjects with a mean age of 46 years (range, 24–75 years). All subjects underwent standardized nerve conduction studies for the median, ulnar, peroneal, posterior tibial, and sural nerves. CSA was measured unilaterally at 21 sites of the median, ulnar, radial, posterior interosseous, superficial radial sensory, musculocutaneous, lateral antebrachial cutaneous, and medial antebrachial cutaneous nerves.According to their age, the subjects were assigned to the younger group (20–40 years, n = 40), the middle group (40–59 years, n = 40), and the older group (60–80 years, n = 27). The significant differences of CSA values between age groups were found only at certain sites, such as the median (wrist, P = .003), ulnar (medial epicondyle, P = .031; forearm, P = .022), radial (antecubital fossa, P = .037), and superficial radial sensory nerve (P = .028). The CSA significantly correlated with gender, height, weight, and body mass index.This study provides CSA reference values for nerves, including small sensory nerves in the upper extremity, which can be useful in the ultrasonographic investigation of various peripheral neuropathies in the upper extremity.     

Peripheral nerve function in patients with familial amyloid polyneuropathy after liver transplantation.

To evaluate the therapeutic efficacy of liver transplantation in patients with ATTR Val30Met familial amyloid polyneuropathy (FAP), were repeatedly examined the neurophysiological function of peripheral nerves in nine patients. The maximal motor and sensory conduction velocities (MCV and SCV) of the ulnar and tibial nerves, size of compound muscle action potential (CMAP), terminal latency of CMAP, skin temperature of extremities, CVR-R, blood pressure, heart rate, and Schellong's test were examined before and every 6 months after the operation. Although there were no changes in CVR-R, blood pressure, or heart rate, the skin temperature of foot and hand increased soon after surgery and did not decrease during the period of observation. The temperature-adjusted MCV of tibial nerve gradually increased, but the MCV of ulnar nerve showed no change. The temperature-adjusted tibial nerve SCV worsened slightly soon after transplantation and remained at that level in the distal part. The ulnar nerve SCV worsened and subsequently improved. Liver transplantation is very effective for halting the progression of this type of FAP, but the recovery of peripheral nerve function in patients seems to be very slow and limited, especially the function of large diameter myelinated fibers.     

Morphological study of the neurovascular bundle to elucidate nerve damage in pelvic surgery

Purpose

Postoperative sexual and urinary dysfunction may occur after rectal cancer surgery involving the pelvis, but this problem cannot be solved. The aim of this study was to examine the nerve morphology of the neurovascular bundle in cadavers to determine possible causes of nerve damage during surgery.

Methods

Twenty-two formalin-fixed cadavers were used in the study. The cadavers were donated to the Tokyo Medical University. The study comprised histological evaluation of paraffin-embedded bilateral neurovascular bundle specimens from the cadavers. Four slides of 3-cm thick were made every 1 cm in a plane perpendicular to the rectum towards the pelvic floor from the peritoneal reflection in bilateral neurovascular bundles in 22 cadavers. The number of nerves, the mean nerve area, and the mean nerve diameter were measured in each slide.

Results

The results were categorized into cases with high (group H) and low (group L) positions of the pelvis 1 cm above and 2 cm below the peritoneal reflection, respectively. There was no significant difference in the number of nerves between these groups. The nerve area and nerve diameter were significantly smaller in group L, and these characteristics were more marked in males.

Conclusions

Our results show that the nerves of the neurovascular bundle became smaller in the deep pelvis. This may cause these nerves to be more susceptible to injury, resulting in nerve damage in the deep pelvis that leads to postoperative dysfunction. Particularly, this type of nerve damage may be a cause of postoperative sexual dysfunction in males.

     

游离指动脉皮支皮瓣移植修复指端皮肤缺损（附8例报告）

目的观察游离指动脉皮支皮瓣移植修复指端缺损的疗效。方法对8例（8指）指端缺损患者按受区需要,在手指近节设计适当大小和形状的指动脉皮支皮瓣,解剖游离皮瓣边缘的浅静脉和指固有神经和指神经背侧支发向皮瓣的分支分别做为皮瓣的回流静脉和感觉神经,解剖游离指动脉发向皮瓣的皮支并在指动脉皮支起始处切断,形成以指动脉皮支为蒂的游离皮瓣。皮瓣移植至指端修复创面,皮瓣上的指动脉皮支与手指远端的指动脉分支或主干吻合,皮瓣神经与指神经残端吻合,皮瓣的静脉与受区浅静脉吻合。结果8例皮瓣全部成活。术后随访3～6个月,皮瓣色泽正常,质软,两点辨别觉3～8mm。结论指动脉皮支皮瓣游离移植修复指端皮肤缺损,皮瓣质地好,指端感觉恢复良好,且不损伤指动脉与指固有神经。