显微手术修复腕部切割伤58例

我科从１９９２年１月～１９９８年５月，收治腕部血管、神经、肌腱切割伤５８例，采用显微外科技术进行修复治疗，疗效满意。１临床资料１．１一般情况本组男３８例，女２０例；年龄１５～７２岁。致伤原因：玻璃切割伤１２例，刀砍伤３６例，机器致伤５例，其他原因５例。血管损伤３２例，其中烧动脉伤１８例，尺动脉伤９例，桡、尺动脉同时受伤５例；神经损伤２９例，其中桡神经９例，正中神经７例，尺神经５例，桡神经伴正中神经伤３例，桡神经伴尺神经伤５例；肌腱伤１４例。血管合并肌腱伤２１例，血管合并神经伤５例，肌腱伴神经伤１…     

接枝水凝胶硅胶膜修复周围神经的临床应用与实验研究

目的运用接枝水凝胶硅胶膜桥接修复周围神经，电镜下观察实验动物神经修复的形态，评价其临床应用的效果。方法临床采用接枝水凝胶硅胶膜桥接修复神经损伤患者共48例，其中锐器伤20例，闭合性骨折合并神经损伤12例，开放性骨折合并神经损伤16例。动物实验将家兔坐骨神经切断，随机分为A、B、C三组，分别予直接缝合、接枝水凝胶粘合、缝合处理，饲养3个月后处死，镜下观察神经纤维再生情况。结果48例患者术后平均随访2—5年，均恢复了痛觉。22例桡神经、7例正中神经损伤患者予接枝水凝胶硅胶膜桥接修复后畸形消失，功能基本正常。15例尺神经损伤患者中4例手内在肌萎缩，功能恢复不佳。动物实验大体观察及镜下观察所见，修复神经断端均与正常神经基本相同。结论接枝水凝胶硅胶膜桥接吻合处神经形态、色泽与正常神经无差异，无吻合口痕迹，术后功能恢复好。     

止血带引起的上肢神经损伤(摘要)(临床与肌电图分析)

北京积水潭医院烧伤科和解放军军医进修学院烧伤科自1967年至1981年的15年期间,在上肢切痂(或切疤)植皮2,576例的3,165例次的手术中,共发现上肢神经损伤22例,发生率为0.69％。其中男性14例、女性8例,年龄19～47岁。使用橡皮止血带17例,气囊止血带5例。正中神经、尺神经和桡神经损伤者10例,正中神经、尺神经、桡神经和肌皮神经损伤者1例,     

显微外科技术在周围神经损伤治疗中的应用

我科于１９７８年３月至１９９３年９月应用显微外科技术修复周围神经损伤４０例４９条神经，经临床观察，收到良好效果。现报告如下。临床资料本组男３５例，女５例，年龄２～７２岁，平均３７岁。损伤部位：高位尺神经损伤７条，腕部正中神经损伤１３条，腕部尺神经损伤...     

手指尺侧岛状皮瓣移植修复手桡掌侧放射损伤一例报告

手指尺侧岛状皮瓣移植修复手桡掌侧放射损伤一例报告杨文峰，杨志祥，孙向黎近年，我们应用手指尺侧岛状皮瓣移植修复桡掌侧的放射损伤，效果良好，现报道如下。患者男性，４７岁。于１９９４年５月６日在排除机械故障时，右手接触放射源。放射源为２３３Ｕ和２３８Ｕ，受...     

周围神经损伤89例患者心理分析及护理体会

周围神经损伤给患者造成较大的痛苦。但因其社会地位、文化素养以及生活环境的不同，其心理状态也不相同。现就我院１９８７年１２月以来收治的周围神经损伤８９例伤员心理状态及护理对策报告如下。１　临床资料本组病人８９例，其中８３例９４条为上肢神经干损伤。６例６条为下肢神经干损伤，正中神经损伤３１条，尺神经损伤４２条，桡神经损伤２１条，坐骨神经损伤２条，腓总神经损伤４条。急诊创伤６８例，陈旧性损伤２１例，电锯伤１４例，刀砍伤６６例，骨折合并神经损伤９例。２　心理分析一般急诊患者都有痛苦、恐惧及急切的心理，但…     

火器性周围神经损伤束间移植吻合35例分析

1979年,我们曾对82例92条四肢火器性神经损伤先后进行了手术修复。本文仅将术后平均随访2年的35例37条神经束间移植吻合术后结果进行分析。 临床资料 一、一般资料 本组36例均为男性青年。37条火器性神经损伤,其中桡神经、正中神经各9条,尺神经12条,坐骨神经4条,胫神经、腓总神经及股神经各1条。致伤特点为损伤范围大,经手术中处理后平     

掌长肌腱在远端尺桡关节脱位手术治疗中的应用(附11例报告)

掌长肌腱串缝修复远端尺桡关节脱位,能达到理想的治疗效果.掌长肌腱修复远端尺桡关节脱位,应逐渐取代传统切除尺骨头的方法.     

桡神经深支损伤的治疗

目的探讨桡神经深支损伤的手术治疗方法与疗效。方法５８例桡神经损伤患者，３３例采用显微外科吻合和移植，１９例神经松解，２例神经残端植入，４例肌腱转位。结果神经吻合和移植优良率９３．９％，神经松解优良率８９．５％，４例肌腱转位疗效均满意，２例神经残端植入者疗效均差。结论对已明确的桡神经深支应尽早手术探查修复；对于鱼尾平面的桡神经深支损伤宜采用肌腱转位。     

桡神经损伤的肌腱移行手功能重建

目的：评估桡神经损伤后前臂屈肌腱移位术重建伸腕、伸拇及伸指功能的效果。方法：1992年10月-2005年10月,前臂屈肌腱移位术治疗不可逆桡神经损伤20例。其中桡神经损伤后缺损12例,桡神经不可逆的挫裂伤8例,均伴伸腕、伸拇及伸指功能障碍,肌力0-1级,前臂背侧肌群萎缩。肌腱移位术距神经损伤或修复时间为6个月-2年。结果：术后20例均经2-60个月随访,术后采用费起礼等〔1〕疗效评定法：优10例,良8例,手功能恢复基本满意;中2例,均为移位肌腱张力不足。结论：前壁屈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。     

携带桡神经浅支的示指背侧岛状皮瓣在拇指尺掌侧皮肤缺损中的应用

目的探讨携带桡神经浅支的示指背侧岛状皮瓣修复拇指尺掌侧皮肤缺损的疗效。方法回顾性分析2014年4月—2017年4月华北理工大学附属骨科医院创伤一科采用携带桡神经浅支的示指背侧岛状皮瓣修复拇指尺掌侧皮肤缺损患者15例(随访12例),男性12例,女性3例;年龄23~55岁,平均36.0岁。左手9例,右手6例。受伤至手术时间1.5~8.0h,平均3.5h。拇指尺掌侧皮肤缺损范围5.0cm×2.0cm^7.0cm×2.8cm,均存在不同程度的尺侧指固有神经血管损伤,骨及肌腱外露。皮瓣切取面积6.0cm×2.5cm^8.0cm×3.0cm。结果15例皮瓣均顺利成活,12例获得随访,末次随访拇指功能及外观恢复非常满意9例,满意3例;拇指伤区皮肤感觉恢复S3,两点辨别觉恢复7.0~10.0mm,平均8.5mm,供区无瘢痕挛缩、肌腱粘连、皮肤溃破等并发症。手功能优9指,良2指,可1指,优良率91.6%。结论利用携带桡神经浅支的示指背侧岛状皮瓣修复拇指尺掌侧皮肤缺损,操作简单,皮瓣成活率高,受区感觉恢复良好,是修复拇指尺掌侧缺损较为理想的方法。     

Sports and peripheral nerve injury

Peripheral nerve injury is one of the serious complications of athletic injuries; however, they have rarely been reported. According to the report by Takazawa et al., there were only 28 cases of peripheral nerve injury among 9,550 cases of sports injuries which had been treated in the previous 5 years at the clinic of the Japanese Athletic Association. The authors have encountered 1,167 cases of peripheral nerve injury during the past 18 years. Sixty-six of these cases were related to sports (5.7%). The nerves most frequently involved were: brachial plexus, radial nerve, ulnar, peroneal, and axillary nerves (in their order of frequency). The most common causes of such injuries were mountain climbing, gymnastics, and baseball. More often, peripheral nerve injury seemed to be caused by continuous compression and repeated trauma to the involved nerve. Usually it appeared as an entrapment neuropathy and the symptoms could be improved by conservative treatment. Some of the cases were complicated by fractures and surgical exploration became necessary. Results of treatment produced excellent to good improvement in 87.9% of the cases. With regard to compartment syndrome, the authors stress the importance of early and precise diagnosis and a fasciotomy.     

Ulnar nerve injuries of the hand producing intrinsic muscle denervation on magnetic resonance imaging

Muscle and nerve injuries in the hand may be difficult to detect and diagnose clinically. Two cases are reported in which magnetic resonance imaging showed ulnar nerve injury and intrinsic hand muscle denervation. The clinical, anatomical and radiological features of injury to the deep motor branch of the ulnar nerve and associated muscle denervation are discussed and illustrated.     

克氏针固定并皮下神经前置术治疗肱骨髁上骨折疗效分析

目的探讨尺神经皮下前置术在治疗肱骨髁上并尺神经损伤的疗效。方法回顾分析2004～2007年收治的此类患者58例,获得随诊50例,分别行单纯克氏针固定和克氏针固定并尺神经皮下前置术,术后评估优良率,观察尺神经恢复疗效。结果单纯固定组优良率为65%,固定并神经前置组优良率为80%,两组疗效不存在显著差异。结论Ⅰ期行尺神经皮下前置能提高尺神经损伤的恢复率,中重度伴有尺神经损伤的患者神经前置远期恢复更佳;未行神经前置的病例,若后期出现迟发性尺神经炎,可再行探查并皮下前置。     

负压封闭吸引结合钢板内固定治疗Gustilo Ⅲ型尺桡骨开放性骨折

目的探讨应用负压封闭吸引结合钢板内固定治疗GustiloⅢ型尺桡骨开放性骨折的疗效。方法治疗GustiloⅢ型尺桡骨开放性骨折12例,受伤原因:机器碾压伤7例,车祸伤4例,重物砸伤1例。均采用负压封闭吸引技术一期结合钢板内固定治疗。结果 12例患者无感染发生,植皮及皮瓣均一期愈合。11例获得骨性愈合,1例出现尺骨不愈合,手术植骨后骨质愈合。结论在早期彻底清创的前提下,负压封闭吸引技术一期结合钢板内固定是治疗GustiloⅢ型尺桡骨开放性骨折一种有效的治疗方法。     

Medial brachial fascial compartment syndrome: anatomic basis of neuropathy after transaxillary arteriography

The authors reviewed their experience with 320 transaxillary arteriograms, as well as the English-language literature on neuropathy complicating transaxillary arteriography. Three of their patients had median and ulnar motor and sensory nerve injury, and six others had only sensory involvement. The occurrence or severity of nerve injury did not correlate well with the size or presence of an observable axillary or arm hematoma. Dissection of the axillae and arms of 25 human cadavers revealed a tough medial brachial fascial compartment (MBFC) outside a thin axillary sheath. The median and ulnar nerves were within the MBFC at an arterial puncture site just lateral to the anterior axillary fold. The radial and musculocutaneous nerves exited the MBFC more proximally. The different levels at which the major nerves of the brachial plexus exit the MBFC explain the anatomic distribution of the nerve injuries associated with compression by a hematoma after transaxillary arteriography.     

肱三头肌肌腱重建环状韧带治疗青少年创伤性桡骨头脱位

目的讨论肱三头肌肌腱重建环状韧带治疗青少年创伤性桡骨头脱位的手术疗效,为临床治疗提供依据。方法回顾性分析解放军第59中心医院2011年5月—2016年9月收治的15例青少年创伤性桡骨头脱位患者,应用肱三头肌肌腱重建环状韧带治疗,男性9例,女性6例;年龄8~18岁,平均14.6岁。道路交通伤8例,摔伤7例;其中桡骨头脱位伴尺骨近段骨折6例,所有病例无神经损伤,无桡骨头骨折。结果 15例青少年患者术后均无手术感染,术后3~24个月内复查,通过Macky肘关节评分及Barthel指数评价疗效,治疗整体效果满意。结论肱三头肌肌腱重建环状韧带治疗青少年创伤性桡骨头脱位手术方式,患者术后肘关节功能活动恢复良好,手术方法简单有效,值得在临床工作中进行推广。     

手部碾压伤的早期软组织修复

目的　探讨手部碾压伤的早期软组织修复。方法　早期采用前臂桡侧皮瓣、前臂尺侧皮瓣、前臂背侧皮瓣、手背桡侧皮瓣、第一掌骨背侧皮瓣、前臂筋膜蒂皮瓣等各种皮瓣修复手部碾压伤。结果　本组均经 1次手术而获修复。结论　早期利用各种皮瓣修复手部碾压伤 ,有利于手部碾压伤后的功能恢复     

Injury to the brachial plexus during Putti-Platt and Bristow procedures. A report of eight cases

Eight patients with documented recurrent anterior dislocation of the shoulder sustained iatrogenic brachial plexus injuries during either Putti-Platt or Bristow procedures. Two patients also sustained axillary artery injuries. There were six males and two females. Postoperatively, complete paralysis of the musculocutaneous nerve was noted in six cases and incomplete paralysis in one case. Two patients had complete axillary nerve palsies. There were two cases of partial paralysis of the radial, median, and ulnar nerves, respectively. Seven of the patients underwent brachial plexus exploration an average of 16 weeks following their initial operation (range, 4 to 40). Suture material was removed from around or within two musculocutaneous nerves and one ulnar, one median, and one axillary nerve. Two lacerated musculocutaneous nerves were amenable to delayed primary repair. Two musculocutaneous, one median and one axillary nerve required grafting. Injury to the brachial plexus was associated with inadequate knowledge of regional anatomy, blind clamping of axillary artery lacerations, use of axillary incisions which limited exposure, and failure to identify the musculocutaneous nerve during Bristow procedures. If a brachial plexus injury occurs during a Putti-Platt or a Bristow procedure and the lesion does not rapidly, progressively, and completely recover, the brachial plexus should be explored since there is a high likelihood of structural neurologic injury.