应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

应用显微外科技术修复上肢神经缺损的临床疗效

目的 报道应用显微外科技术修复上肢神经缺损的临床疗效.方法 应用腓肠神经移植修复上肢神经缺损52例52条,其中正中神经损伤25条,伴肱动脉损伤4条;尺神经损伤14条,伴尺动脉损伤5条;桡神经损伤13条.结果 随访6个月～10年,平均4.5年,采用中华医学会手外科学会上肢外周神经功能评定试用标准评分,结果总优良率81.6%.结论 应用显微外科技术修复上肢神经可获较好的临床效果.     

显微外科技术在周围神经损伤修复中的应用

目的：分析应用显微外科技术在修复周围神经损伤中影响其疗效的因素及处理措施。方法：从１９８７年至１９９７年，用显微外科技术修复周围神经损伤８０例９２条神经，方法包括神经松解术、神经外膜缝合术、外膜束组膜缝合术、束膜缝合术和神经移植术。结果：经术后１８个月～６０个月随访，优良率８０．４％。结论：神经断端精确对合和及早修复可提高其疗效；不同神经、不同的损伤平面、损伤程度不同，采用不同的缝合方法     

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。     

Management of small artery vascular trauma.

This 11-year retrospective study reviewed 99 arterial injuries distal to the brachial bifurcation or popliteal trifurcation in 89 extremities in 88 patients. Associated injuries occurred in 78 of 88 (89%) patients, including 10 fractures or dislocations, 66 nerve injuries, and 59 single or multiple tendon injuries. Fasciotomy was performed in 9 upper extremities and 11 lower extremities (23% of patients). The selection of operative treatment by arterial repair or ligation was by surgeon choice (52% repair and 48% ligation). Postoperative patency was found in 45 of 47 (96%) repaired arteries. In cases of isolated single arterial injuries (10), there were excellent results, and there was no difference in the results between repair and ligation. In cases of nonisolated single arterial injuries (69), there were 46% and 36% nonvascular complications in the repaired and ligated groups, respectively. In 10 patients with nonisolated multiple arterial injuries in the same extremity, the results of repair of one artery with ligation of the other artery versus repair of both arteries were identical, and there were no vascular complications. Operative exploration was the key to complete evaluation of vascular and neuro/musculoskeletal injuries. The data suggest that one functional artery distal to the elbow or knee is sufficient for limb viability and vascular function (follow-up range: 0 to 110 months; mean: 12 months). Nerve injury was the single most important factor of extremity injury in terms of the degree of functional loss.     

Vascular injuries in everyday practice

BACKGROUND: It was the objective of this retrospective study to analyse the causes of injury, surgical approaches, outcome, and complications in patients with vascular trauma and to report our experience with vein homografts for arterial reconstruction in the upper and lower limbs and cervicothoracic region in patients operated on over a period between 1981-2001. PATIENTS: In 128 patients with peripheral arterial injuries the mechanism was direct penetration in 90 cases and blunt injury in 20 cases. In 4 cases a chronic damage (false aneurysm, AV fistula) was observed. Isolated vascular trauma was present in 97 patients (75.8%), 31 cases (24.2%) were aggravated by concomitant bone fractures, and nerve or soft tissue damage. Most frequently injured vessels were the superficial femoral (22.6%), crural (22.6%), and ulnar and radial (13.2%) arteries. 16 patients with penetrating cervicothoracic arterial injuries were registered during this period. 8 patients underwent emergency exploration and 8 patients angiography prior urgent exploration. RESULTS: Saphenous vein interposition grafting was applied with good results in 34 patients, polytetrafluoroethylene and Dacron grafts were used in eight cases, end to end anastomosis in 12 cases, venous bypasses in 5 cases, venous patches in 7 cases. 17 patients underwent arterial repair and 9 venous repair. Vein homografts as an arterial substitute were implanted in 8 patients. Five secondary amputations were performed and five patients died. The limb salvage rate was 95% and the primary patency rate of vein homografts was 75% (excluded primary amputations). The penetrating cervicothoracic injuries were all repaired with improvement in level of consciousness and neurological deficit when present. CONCLUSIONS: Most vascular injuries of the extremities can be managed successfully unless associated with severe concomitant damage of the bones, nerves and soft tissues. In the absence of suitable autologous vein grafts, homografts appear to be an interesting alternative for arterial repair. In penetrating cervicothoracic vascular injuries immediate operative repair offers the best chance of recovery.     

Surgical treatment of common peroneal nerve injuries: indications and results. A series of 62 cases

AIM: Common peroneal nerve (CPN) injuries represent the most common nerve lesions of the lower limb and can be due to several causative mechanisms. Although in most cases they recover spontaneously, an irreversible damage of the nerve is also likely to occur. Nerve regeneration following CPN repair is poorer if compared to other peripheral nerves and this can explain the reluctant attitude of many physicians towards the surgical treatment of these patients. Among the several factors advocated to explain the poor outcome following surgery, it has been suggested that reinnervation might be obstacled by the force imbalance between the functioning flexors and the paralysed extensors that eventually results in the fixed equinism of the foot, due to the excessive contracture of the active muscles and the shortening of the heel cord. Therefore the early correction of these forces might favour nerve regeneration. Following such hypothesis, the authors treat irreversible CPN injuries performing a one-stage procedure of nerve repair and tibialis tendon transfer. We report our experience, describing the indications to surgical treatment, the operative technique and the postoperative clinical outcome correlated with the causative mechanisms of the injuries. METHODS: A 62-patient series controlled over a period of 15 years with a post-traumatic palsy of the CPN is reported. All the patients underwent surgery. In open wounds, when a nerve transection was suspected, surgery was performed at emergency (2 cases). In closed injuries, operative treatment was advised when no spontaneous regeneration occurred 3-4 months after the injury. From 1988 till 1991, 9 patients were elected for surgery : in 6 cases treatment consisted of neuroma resection and nerve repair by means of a graft. In 3 patients it was performed only a CPN decompression at the fibular neck. Since 1991, surgical treatment has always consisted of nerve repair associated with a tendon transfer during the same procedure. Fifty-three patients were elected for surgery. Nerve repair was achieved by direct suture in 1 case and by means of a graft in 46 patients. Decompression of the CPN at the fibular neck was performed in 6 patients where nerve continuity was demonstrated. RESULTS: In the first group of patients, nerve repair outcome was highly disapponting: no recovery in 5 cases, reinnervation occurred in 1 patient only (M1-2). CPN decompression was followed by complete recovery in 2 cases, no improvement was observed in 1 case. Nerve repair associated with tibialis tendon transfer dramatically improved the postoperative outcome: at 2 year follow-up, neural regeneration was demonstrated in 90% of the patients. Surgical outcome depends on the causative mechanisms of the lesion: sharp injuries and severe dislocations of the knee had an excellent recovery, while in crush injuries and gunshot wounds good recovery was less common. CONCLUSION: Surgical treatment of CPN injuries can nowadays be highly rewarding. CPN palsies in open wounds should undergo surgical exploration at emergency. In close injuries with no spontaneous recovery within 4 months after the injury, patients should be advised to seek surgical treatment regardless the causative mechanism of the lesion. According to our experience, the association of a transfer procedure to nerve repair enhances neural regeneration, dramatically improving the surgical outcome of these injuries.     

Common peroneal nerve injuries: results with one-stage nerve repair and tendon transfer

The authors report their experience in the treatment of common peroneal nerve (CPN) injuries using a one-stage procedure of nerve repair and tibialis posterior tendon transfer. A series of 45 patients with traumatic injury and graft repair of the CPN is presented. From 1988 to 1991, the six patients elected for surgery had only nerve repair: five ultimately did not recover, while muscle contraction in the remaining patient was graded M1-2. Since 1991, nerve surgery in our clinic was associated with tendon transfer procedures (39 cases) which were followed by a satisfactory reinnervation rate. Nerve transection and iatrogenic injuries, torsion/dislocation of the knee, complex biosseous fractures of the leg, and gunshot wounds showed excellent to fair results in decreasing order: in nerve sections, muscle recovery scored M3 or M4+ in all the patients, and in nerve ruptures due to severe dislocation of the knee, it was M3 or M4+ in 85% of cases. The association of microsurgical nerve repair and tendon transfer has changed the course of CPN injuries.     

Common peroneal nerve injuries

The authors report their experience in the treatment of common peroneal nerve (CPN) injuries using a one-stage procedure of nerve repair and tibialis posterior tendon transfer. A series of 45 patients with traumatic injury and graft repair of the CPN is presented. From 1988 to 1991, the six patients elected for surgery had only nerve repair: five ultimately did not recover, while muscle contraction in the remaining patient was graded M1-2. Since 1991, nerve surgery in our clinic was associated with tendon transfer procedures (39 cases) which were followed by a satisfactory reinnervation rate. Nerve transection and iatrogenic injuries, torsion/dislocation of the knee, complex biosseous fractures of the leg, and gunshot wounds showed excellent to fair results in decreasing order: in nerve sections, muscle recovery scored M3 or M4+ in all the patients, and in nerve ruptures due to severe dislocation of the knee, it was M3 or M4+ in 85% of cases. The association of microsurgical nerve repair and tendon transfer has changed the course of CPN injuries.     

尺神经损伤402例报告

目的 介绍尺神经损伤的治疗方法和疗效。方法 ４０２例尺神经损伤，上臂４４例，肘部６１例，前臂１３８例，腕部１３４例，掌部２５例，完全断伤３１２例，部分断伤２２例，神经粘连６８例，行神经松解术７２例，神经直接缝合２８６例，束组束膜缝合３１例，神经移植１３例，结果 按顾玉东的低位神经功能评定标准评定，优１１７例，占２９．１％，良１３４例，占３３．３％，可１０５例，占２６．１％，差４６例，占１１．５％，     

儿童桡神经损伤78例分析

目的讨论儿童桡神经损伤的临床特点和治疗方法。方法对７８例儿童桡神经损伤的临床资料进行总结和分析。伤因：６６例为上肢骨折或脱位时合并神经损伤，其中肱骨下段骨折７例，肱骨髁上骨折３７例，孟氏骨折或单纯桡骨头脱位１８例，尺骨和／或桡骨骨折４例。１２例为单纯神经损伤。采用手法复位、石膏固定或牵引１８例，神经松解术３８例，神经吻合术２０例，肌腱转移功能重建术２例。结果４２例随访２个月～２６年，平均４年２个月。用Ｈｉｇｈｅｔ运动评定法评定，疗效为优者３４例，优良率达８１％。伤后３个月内治疗者优良率占９６．５％，明显优于伤后６个月处理者的５０％。结论儿童上肢骨折脱位易合并桡神经损伤，对开放性骨折合并桡神经损伤者应尽快手术治疗。闭合性损伤在保守治疗１～３个月后功能无恢复时应考虑手术治疗     

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。