腕部正中神经显微修复的临床分析

显微外科技术用于周围神经的修复 ,其优越性已在临床上得到广泛肯定。我院自 1 988年～ 1 997年 ,采用神经束膜缝合法和神经外膜缝合法分别对1 39例腕部正中神经损伤行急诊一期修复。临床对比观察 ,神经束膜缝合法的疗效优于神经外膜缝合法 ,现总结报告如下。1　临床资料1 .1     

外伤性前臂正中神经损伤的治疗

目的　总结外伤性前臂正中神经损伤的治疗经验。方法　对 63例正中神经损伤 ,采用神经端端缝合术 (外膜、束膜缝合 )、神经内外松解术、神经移植术三种方法修复。结果　 63例术后随访 1～ 4年 ,平均 1年 8个月。按中华医学会手外科学会上肢部分功能评定试用标准评定 ,优良率为 66.7%。结论　提高疗效的经验是对不同的伤情采取不同的处理及系统的康复训练。     

腋动脉及正中神经损伤修复一例

1　病例介绍患者　女 ,6 5岁。不慎摔倒后即感左肩部剧痛 ,不能自主活动。于伤后 1小时就诊 ,X线片显示“左肱骨外科颈骨折伴肩关节脱位”手法复位失败后行钢丝托超肩、肘外固定。检查 :患肢肿胀明显 ,尺桡动脉搏动减弱 ,左手掌桡侧与桡侧三指半痛触觉减退 ,左拇指对掌受限 ,受伤 12小时后患肢远端皮温明显较健侧低、尺桡动脉搏动未能扪及。诊断 :左肱骨外科颈骨折 ,腋动脉及正中神经损伤 ,立即行“左肱骨外科颈骨折伴肩关节脱位切开复位克氏针内固定术”,“腋动脉、正中神经探查术”。采用肩关节前内侧切口 ,劈开三角肌 ,术中发现腋动脉和…     

实验研究：正中神经损伤晚期修复的实验研究

目的 通过对正中神经损伤晚期修复方法的探索，验证晚期神经损伤修复后，最大限度获得满意功能恢复的程度。方法 模拟兔实验伤后6个月、9个月、12个月进行神经修复，按国际统一标准评定疗效。结果 36只中恢复优良23例，总优良率为63．9％。结论 伤后较长时间以上的晚期周围神经损伤的修复仍可获得较满意的恢复。     

正中神经损伤后动力性对掌功能重建

我院 1994年 6月～ 2 0 0 0年 10月 ,收治正中神经损伤对掌功能丧失 2 5例 ,4例采用骨性手术 ,2 1例采用肌腱移位方法重建对掌功能 ,术后对掌功能恢复。报告如下。1　临床资料本组 2 1例 ,男 17例 ,女 4例。年龄 14～ 4 8岁。左侧 6例 ,右侧 15例。损伤原因分别为切割伤 11例 ,牵拉伤 7例 ,压迫性损伤 3例。伤后就诊时间 4～ 18个月。其中正中神经全干麻痹6例 ,前臂锐器伤合并尺神经损伤 2例 ,臂丛神经牵拉伤合并桡神经麻痹 1例。患者拇指外展功能丧失 ,大鱼际肌萎缩 ,伴不同程度的前臂旋前、屈腕、屈拇、屈指功能障碍。2　手术方法行臂丛神…     

Interfascicular Transplantation in Median Nerve Injuries

Twenty-four patients operated upon within a 3-year period for complete median nerve transection using the microsurgical interfascicular transplantation technique were examined after a minimum of 3 years' observation. Functional motoricity (M 3 or higher) was achieved by 83 per cent. With the exception of one patient, all achieved protective tactile sensibility (96 per cent). the results were best for distal lesions in children and youths. the outcome was just as satisfactory as that attained with epineurial suture carried out under ideal conditions. the method was found to be superior to epineurial end-to-end suture in cases of nerve defects longer than 2.5 cm.     

Evaluation of Tension at Median and Ulnar Nerve Repairs at the Wrist in a Cadaveric Model

Background: Median and ulnar nerve lacerations at the wrist are often combined with zone 5 tendon injury. The inability to provide early range of motion leads to increased adhesions. Current therapy protocols recommend the wrist be held in 30° of flexion post operatively to protect the nerve repair. However, if tension and elongation across the nerve repair stay under a critical level in less wrist flexion, postoperative splinting in more extension could allow for better tendon excursion and less adhesions. Methods: Six cadaveric specimens were used. After appropriate dissection, the median and ulnar nerves were transected and repaired with a single 10-0 nylon suture. The wrist was ranged from 30° flexion to 45° extension to see if the repair would fail. Next, an epineural repair was accomplished with 9-0 nylon suture. The percent elongation along the nerve repair was measured at set increments from 30° flexion to 45° extension. Results: In all 6 specimens, median and ulnar nerve repairs with a single 10-0 nylon suture did not fail with wrist range of motion from 30° flexion to 45° extension. Mean percent elongation stayed under critical levels in up to 30° of extension. Conclusions: Both median and ulnar nerve repairs stayed under critical levels of tension and elongation in up to 30° of wrist extension. We believe it is possible to be more aggressive with wrist positioning in wrist level median and ulnar nerve repairs.     

臀部外伤性坐骨神经损伤的手术治疗

目的探讨臀部外伤性坐骨神经损伤手术治疗的指征及效果. 方法对21例外伤性臀部坐骨神经损伤者进行手术治疗,方法包括神经探查、松解、减压、路径清理及神经吻合. 结果平均随访2.98年,坐骨神经恢复优良率为57.1%. 结论臀部外伤性坐骨神经损伤以腓神经较多见,且预后不佳;伤后应早期手术治疗,术中应注意判断坐骨神经的行径、损伤或严重情况,避免漏治.     

Processus Supracondyloidea Humeri with Concomitant Compression of the Median Nerve and the Ulnar Nerve

Compression of the median nerve and the ulnar nerve due to the anatomical anomaly processus supracondyloidea humeri is a rare condition. a case of combined median and ulnar nerve compression is described. Diagnostics and treatment are discussed in the light of the present case history and those described in the literature. The conclusion is that the treatment should be subperiosteal resection of the process together with the origin of the pronator teres muscle.     

Bifid Median Nerve in Trauma Patients: How Rare Is it?

Abstract Bifid median nerve is a rare anatomic variation and it can be in danger during various elective procedures as carpal tunnel release, flexor tenosynovectomy and certainly in trauma cases. Hand surgeons must be aware of this anatomical anomaly to avoid damaging the nerve.