带蒂骨间前神经转位移植修复上肢神经干缺损

报道采用带血管的骨前神经转位移植修复上肢神经干缺损１２例，缺损长度４．５～１２．６ｃｍ，损伤至修复时间，６小时～１０．５个月，经随访１．５～６年，优６例，良４例，可１例，差１例，优良率为８３％。     

胸长神经卡压的诊断和治疗

目的：探讨胸长神经卡压的诊断和治疗：方法：对近6年来收治的16例胸长神经卡压的病史进行分析，发现患者共同的特点足胸前、胸侧壁和腋部不适，针剌样疼痛：12例行非手术治疗，4例行手术治疗。结果：非手术治疗中1例失访，11例获6个月以上的随访，其中2例效果不佳后期改手术治疗，6例手术治疗后随访6个月～4年，症状全部消失。结论：胸长神经卡压引起的胸部疼痛并不罕见，一旦确诊，可先行非手术治疗，以颈部局封为主要治疗方法，如无显著效果应采取手术治疗。     

神经肌腱对吻法预防截指术后神经瘤性疼痛

目的探讨神经肌腱对吻法预防截指术后神经瘤性疼痛疗效。方法临床200例急诊人院手外伤需截指患者，按手术先后随机分成实验组（常规截指术中采用神经肌腱对吻法处理手指神经残端）和对照组（常规截指术未作处理），每组100例。结果术后200例中失访14例，186例随访6个月～2年，按残端指神经瘤性疼痛发生率，实验组明显低于对照组。结论神经肌腱缝合法处理手指神经末梢是一种有效的预防神经瘤性疼痛的方法。     

膈神经移位至臂丛上干前股的临床应用及疗效分析

目的：报道膈神经移位至臂丛上干前股的临床应用，分析疗效欠佳的原因并探讨应对措施。方法：回顾白1999年3月-2005年2月行膈神经移位至臂丛上干前股术式的38例患者手术情况，对肌皮神经恢复情况进行随访并功能评定，并对影响疗效的各因素进行分析以探讨相应的防治措施。结果：获15个月以上随访患者共29例，优良率为62．1％，功能恢复优良组与非优良组患者的病程及牵拉伤比率存在显著性差异（P〈0.05）。再手术探查发现手术失败的原因有：神经吻接口张力大、存在臂丛的组成变异及多段损伤等。基于神经解剖特点，作者针对减低膈神经吻接口张力提出了手术改良措施并取得满意的疗效。结论：影响该术式疗效的因素有多种，严格把握手术适应症及术中仔细探查是提高治疗效果的关键；通过术式改良可有效降低神经吻接口张力，有助于神经恢复。     

腓肠神经营养血管皮瓣的临床应用

目的 探讨腓肠神经营养血管皮瓣顺行转位修复小腿上段软组织缺损。逆行转住修复小腿中下段及足部软组织缺损的临床应用效果、探讨皮瓣转位面积及血管蒂部的处理方案。方法 在小腿后侧以腓肠神经体表投影为轴心线，设计及切取腓肠神经营养血管筋膜皮瓣，顺行转位修复小腿上段软组织缺损6例，逆行转位修复小腿中下段及足部软组织缺损51例。结果 54例皮瓣完全成活,3例皮瓣远端部分坏死，皮下组织成活，经植皮愈合，经随访皮瓣外观、质地、功能良好。结论 腓肠神经营养血管皮瓣血供可靠，操作简单，可以修复胫前区、踝部及足部跖骨中段近侧软组织缺损。     

腹膜神经胶质瘤病

腹膜神经胶质瘤病是卵巢实性畸胎瘤合并神经胶质组织的腹膜种植现象。报道的８例中，活检时平均年龄１７．４岁。卵巢畸胎瘤最大直径是３０ｃｍ，平均２１．４ｃｍ。５例的肿瘤包膜局部缺损邻近脏器粘连。１例卵巢畸胎瘤术后１０个月，二次手术时发现腹膜播散。我们认为肿瘤包膜的缺损是导致腹膜的主要原因，腹膜种植结节总是由胶质纤维酸性蛋白和Ｓ－１００蛋白阳性并成熟的神经胶质组织组成。本组的平均随访期３６．２个月。其中病     

股神经比邻关系与嵌压症的显微外科神经松解术

在观察９侧成人髂腰部解剖标本股神经干髂腰部比邻关系的基础上，改进了髂腰部股神经手术探查入路，对６侧股神经嵌压症患者施显微外科神经松解术，术后随访一年以上，股四头肌功能恢复满意。     

胚胎发育不良性神经上皮瘤9例临床病理分析

目的 增进对胚胎发育不良性神经上皮瘤(dysemhryoplastic neroepithelial tumors，DNT)临床病理特征的认识。方法 复习9例DNT的临床表现、放射学、病理形态学及免疫组化特征。结果 9例均为20岁以前发病，以癫痫小发作为主要表现，肿瘤均位于大脑皮层内，影像学均无占位效应和瘤周水肿。组织病理学上，皮层内“特异性胶质神经元成分”呈结节状分布，例1、4～9为单纯型，例2、3为复合型。随访：例1术后5年无复发，例3术前2年病灶无变化，另7例仍在随访中。结论 DNT是以20岁前起病、难治性癫痫小发作、由“特异性胶质神经元成分”构成皮层发育不良灶为特征的良性神经上皮肿瘤，可被CT或MRI发现而确诊，绝大多数病例手术切除不复发，预后良好。复合型中极少数病例的胶质瘤成分有复发和恶变的可能。     

神经电图对周围性面神经炎的诊断意义

应用神经电图对９６例周围性面神经炎患者进行检测，并对其中４７例患者进行随访发现：患者额肌、上唇方肌神经电图检查时其波幅、传导速度患侧较健侧低；在临床恢复过程中波幅，传导速度有恢复趋势；病情预后差者波幅、传导速度比预后好者下降更明显。面肌神经电图检查对估计周围性面神经炎预后有帮助。     

臂丛神经损伤患者膈神经移植肌皮神经的电生理观察

目的：评估膈神经功能测定在臂丛神经损伤神经移植前的应用价值,术后电生理观察神经移植恢复状况。方法：对50例臂丛神经损伤患者术前进行了膈神经功能测定,对其中10例膈神经功能正常者,行同侧膈神经移植肌皮神经手术,术后神经电生理随访观察肱二头肌肌电图及肌皮神经运动传导功能状况。结果：臂丛神经损伤患者约28％伴膈神经损伤,损伤的膈神经不能选择为移植动力神经。隔神经移植肌皮神经后,最早3个月出现再生电位,6个月后出现运动单位电位,12个月后运动单位电位明显增多。术后肱二头肌肌力18个月后恢复优良占80％。7例术后12个月肌皮神经引出运动神经传导电位。结论：膈神经功能测定在臂丛神经损伤患者术前可评估选择移植神经,术后电生理可随访观察神经功能恢复状况,对臂丛神经损伤患者的手术治疗有一定指导作用。     

大鼠异体神经移植后再生神经生物力学性质研究

用Ｗｉｓｔａｒ鼠作为实验模型,切下１ｃｍ坐骨神经,再用同系Ｗｉｓｔａｒ鼠坐骨神经异体桥接,修复坐骨神经的缺损,术后２４周对Ｗｉｓｔａｒ鼠的手术侧与正常侧用指标抗张强度与弹性模量（ε＝１０％）进行测试,辅以电镜,光镜观察。     

Masseteric nerve: A possible donor for facial nerve anastomosis?

In the medical treatment of facial nerve paralysis a large number of different techniques have been developed to restore the function of the facial nerve. These include (a) the ipsilateral nerve grafting (e.g., partial hypoglossal-facial, spinal accessory-facial, partial glossopharyngeal-facial), (b) crossfacial nerve grafting and (c) temporal muscle flaps or even free muscle transfers. None of these techniques uses the masseteric nerve as a graft for reconstruction of the facial nerve. This preliminary report deals with the anatomical basis, which could lead to a new technique. The masseteric nerve leaves the infratemporal fossa through the mandibular notch, accompanied by the masseteric artery. At this level the nerve consists in nine of 36 cases studied of only one branch (25.0%), in 17 cases of two branches (47.0%), in nine cases of three (25.0%), and in the remaining case of four branches (2.8%). There are three main reasons for considering the masseteric nerve as a possible donor for at least the orbicular branch of the facial nerve: (1) The approach to the mandibular notch is quite simple; (2) since the nerve consists of two or more branches in 75.0% of the cases, severe dysfunction of the masseter muscle should not occur; (3) if there is complete denervation of the masseter muscle, its function may be taken over by the temporalis muscle. Clin. Anat. 11:396–400, 1998. © 1998 Wiley-Liss, Inc.     

Sural-tibial nerve communications in humans

We investigated the occurrence of a communication between the sural and tibial nerves in 49 legs of 28 Japanese cadavers. In front of the calcanean tendon, we found the communication in 7 legs (14.3%) or in 5 cadavers (18.9%). The sural nerve gave rise to a number of medial and lateral branches, including the lateral calcanean branch at the lateral side of the ankle. The communicating branch with the tibial nerve arose from the first medial branch and pierced the deep fascia of the leg. In 4 cases, the U-shaped communication was formed between the sural and tibial nerves, and in 3 cases, the Y-shaped communication. Electrophysiologi-cal evidence of an anomalous motor function of the sural nerve has been reported recently. We consider that the U-shaped communication between the sural and tibial nerves gives a morphological basis to the motor function of the sural nerve.     

Intramuscular Martin-Gruber anastomosis

The incidence and morphology of the intramuscular Martin-Gruber anastomosis are presented based on the study of 118 human cadavers (55 male, 63 female). The Martin-Gruber anastomosis was found in 25 (21.2%) of the 118 cadavers. It occurred in 11 (20%) of the 55 male cadavers (4 bilateral, 7 unilateral; 5 left and 2 right) and in 14 (22.2%) of the 63 female cadavers (2 bilateral, 12 unilateral; 8 left and 4 right). Therefore, the Martin-Gruber anastomosis was found in 31 (13.1%) of the 236 upper limbs. According to a recent classification (Rodríguez-Niedenführ et al., 2000), pattern I was found in 29 cases (93.5%), corresponding to Type A in 13 (41.9%), Type B in 3 (9.7%) and Type C in 13 (41.9%), whereas pattern II was found in 2 cases (6.5%), both being a duplication of Type IC. Intramuscular Martin-Gruber anastomosis was a single anastomosis that originated in all cases from the anterior interosseous nerve (pattern IC) and then passed through a muscle bundle of the flexor digitorum profundus and behind the ulnar artery to join the ulnar nerve as a single connecting branch. It did not send branches to the flexor digitorum profundus. This intramuscular course was observed in 3 of the 13 cases of Type C anastomosis (23.1%) or 3 cases out of 31 Martin-Gruber anastomoses (10%).     

Martin-Gruber anastomosis revisited

Based on a study of 70 human cadavers (31 male, 39 female) and on cases described previously, we propose a new classification of the Martin-Gruber anastomosis, a neural connection between the median and ulnar nerves in the forearm. The anastomosis was found in 16 (22.9%) cadavers, being bilateral in three (18.7%) and unilateral in 13 (81.3%), five right and eight left. It occurred in eight (25.8%) of the 31 male cadavers and in eight (20.5%) of the 39 females. Therefore, the anastomosis was found in 19 (13.6%) of the 140 forearms. In Pattern I (89.5%) the anastomosis was made by only one branch, whereas in Pattern II (10.5%) it was made by two. The individual branches were classified as Types a, b, and c based on the nature of their origin from the median nerve. Type a (47.3%) arose from the branch to the superficial forearm flexor muscles, Type b (10.6%) from the common trunk, and Type c (31.6%) from the anterior interosseous nerve. Pattern II was a duplication of Type c (10.5%). The anastomotic branch took an oblique or arched course before joining the ulnar nerve, undivided in 15 cases, but divided into two branches in four cases. The anastomosis passed in front of the ulnar artery in four cases, behind it in six, and in nine cases it was related to the anterior ulnar recurrent artery.     

The normal and variant clinical anatomy of the sensory supply of the orbit

Orbital and retro‐orbital pain are relatively common clinical conditions that are associated with such disorders as trigeminal, lacrimal, and ciliary neuralgia, cluster headaches, paroxysmal hemicrania, inflammatory orbital pseudotumor, trochleitis, and herpetic neuralgia ophthalmicus, thus making the nerves supplying the orbit of great clinical importance. Surprisingly, how pain from this region reaches conscious levels is enigmatic. Classically, it has been assumed that pain reaches the ophthalmic division of the trigeminal nerve (V₁) and travels to the descending spinal trigeminal nucleus. However, exactly where the receptors for orbital pain are located and how impulses reach V₁ is speculative. In this project, we reviewed all of the reported connections between the orbital nerves and V₁ in order to understand how pain from this region is transmitted to the brain. We found reported neural connections to exist between cranial nerve (CN) V₁ and CNs III, IV, and VI within the orbit, as well as direct neural branches to extra‐ocular muscles from the nasociliary, frontal, and supraorbital nerves. We also found reported neural connections to exist between the presumed carotid plexus and CN VI and CN V₁, CN VI and CN V₁ and V₂, and between CN V₁ and CN III, all within the cavernous sinus. Whether or not these connections are sympathetic or sensory or some combination of both connections remains unclear. An understanding of the variability and frequency of these neural connections could lead to safer surgical procedures of the orbit and effective treatments for patients with orbital pain. Clin. Anat. 27:169–175, 2014. © 2014 Wiley Periodicals, Inc.     

bFGF对同种异体神经移植后周围神经再生的影响

目的 :探讨bFGF对同种异体神经移植后周围神经再生的影响。方法 :将反复冻融的大鼠神经移植于另一大鼠的坐骨神经 ,实验组注射bFGF 1 0 0u/d共 1 0d ,对照组注射生理盐水 1 0d。术后大鼠存活 1 2周 ,光镜下用体视学方法测试再生神经纤维的面数密度 (NA)、面积密度 (AA)、横切面面积 (AE)、脊髓前角运动细胞和脊神经节细胞的体密度 (VV)、数密度 (NV)。结果 :两组均可见再生神经纤维长入异体移植神经并向远段延伸。实验组再生神经纤维的NA、AA、脊髓前角运动细胞和脊神经节细胞的VV、NV 与对照组的比较 ,有显著性差异。结论 :bFGF能促进周围神经再生 ,对脊髓前角运动细胞和脊神经节细胞的存活有保护作用。     

神经生长因子对周围神经损伤后再生和修复的实验研究

手术切除５ｍｍ兔的尺神经，在两断端间连接肌桥并套装硅胶管，形成一个封闭腔，向腔内注入神经生长因子。间隔不同时间取尺神经桥接区、桥接区近段、远段、尺神经的脊髓投射节段和相应脊神经节，用光镜和电镜观察神经溃变和再生情况并作图像分析；用酶标示踪和电生理方法检测神经通路的重建状况。结果显示，周围神经离断后，肌束桥接并用硅胶管套装后注入外源性神经生长因子，可明显地促进离断神经的再生和修复。     

Influence of a fabella in the gastrocnemius muscle on the common fibular nerve in Japanese subjects

The fabella is a sesamoid bone located in the proximal tendon of the gastrocnemius muscle. In rare cases, its presence may lead to a variety of clinical problems, including fabella syndrome and common fibular (CF) nerve palsy. The purpose of this study was to analyze the morphology of the fabella and CF nerve and discuss the influence of any existing fabellae on the size of the CF nerve. The morphology of the fabella and CF nerve in the popliteal region of the lateral head of the gastrocnemius muscle was investigated in 102 knees of 51 Japanese cadavers. The maximum circumference of the thigh, knee, and calf and the frequency, position, and size of the fabella were measured. In addition, the CF nerve width and thickness were measured proximal to the fabellar region and again as the CF nerve passed posterior, lateral, or medial to the region. A fabella was observed in 70 knees (68.6%). The CF nerve adjacent to the fabella was significantly wider and thinner than in the region proximal to the fabella (P < 0.001). In cases in which a bony fabella was present, there was a significant relationship between the thickness of the CF nerve and the circumference of the thigh and knee. The following factors were observed to contribute to the presence of a fabella causing alterations in the size of the CF nerve: a bony fabella, a CF nerve path posterior or lateral to the fabella, and subjects with a thin physique and bony fabella. Clin. Anat. 26:893–902, 2013. © 2012 Wiley Periodicals, Inc.     

耳大神经移植治疗面神经麻痹的应用解剖学研究

用22具成年尸体的44侧耳大神经进行了解剖观察和测量.耳大神经的平均长度为4.12cm,有2～4个分支.耳大神经的体表投影相当于胸锁乳突肌后缘中点稍下方至耳垂的连线,主干在颈外静脉后方约0.7cm.结果表明:耳大神经是用于神经移植治疗面神经麻痹较理想的神经移植物,耳大神经的体表投影、颈外静脉及下颌角是术中寻找的可靠标志.