延迟一期修复外周神经损伤38例报告

目的 探讨应用显微外科技术延迟一期修复四肢外周神经损伤的治疗体会。方法 应用显微外科技术延迟一期修复各种原因所致的四肢外周神经损伤38例41条，手术方法包括神经瘢痕松解、神经直接缝合术等。结果 术后随访6个月～7年，平均33个月，优良率为81．6％。结论 对失去一期修复手术治疗机会的周围神经损伤患者应尽早行延迟一期手术，可取得较好疗效。     

神经端侧吻合治疗周围神经损伤的临床应用

目的 寻求治疗晚期周围神经损伤伴神经缺损的新方法,以期简化操作,减小手术创伤,提高手术疗效。方法 在实验研究成功报告的基础上,选择晚期周围神经损伤伴神经缺损或臂丛神经根性损伤的患者进行神经端侧吻合术。结果 14例病人经术后6月～16月随访,受损神经术后功能完全恢复者13例,部分恢复者1例。结论 神经端侧吻合术是以基础研究为依据,正确指导临床应用的崭新术式,对修复晚期周围神经损伤伴神经缺损具有操作简单、创伤小、疗效快等优点,值得临床进一步研究及推广。     

周围神经损伤的显微外科修复

目的：分析应用显微外科技术在修复外周神经损伤中影响其疗效的因素及措施。方法：应用显微外科技术修复周围神经损伤300例345条神经,手术方法包括神经外膜缝合术、外膜束膜缝合术、束膜缝合术、神经移植术和神经松解术。结果：术后随访6～72个月,平均优良率74．8％。结论：应用显微外科技术对损伤神经的精确对合和及早修复能够提高疗效。     

不同原因周围神经损伤临床治疗效果分析

目的探讨周围神经损伤的诊治方法和疗效。方法对139例各种原因造成的周围神经损伤患者进行手术或保守治疗,手术方法包括纤维束间松解术、外膜束膜联合吻合术、神经移植术。根据英国医学研究院颁布的神经感觉、运动分级标准评定疗效。结果本组99例患者获随访,占71.2%;随访时间3个月～10 a。平均14个月,优良率达68.8%。结论周围神经损伤是一类致残率较高的疾病,应早期诊断,积极采取各种有效处理措施,以取得更好的治疗效果。     

神经束膜吻合术与神经外膜吻合术治疗尺神经损伤的效果比较

目的比较神经束膜吻合术和神经外膜吻合术治疗腕部尺神经损伤的效果。方法将80例腕部尺神经断裂伤患者按治疗方法分为神经束膜吻合组(42例)与神经外膜吻合组(38例)。比较两组患者术后尺神经传导速度、复合肌肉动作电位波幅和临床疗效。结果患者均获得12个月随访。术后3、6、12个月,尺神经传导速度、复合肌肉动作电位波幅神经束膜吻合组明显优于神经外膜吻合组(P 0.001)。术后12个月临床疗效优良率神经束膜吻合组(81.0%)高于神经外膜吻合组(47.4%)(P 0.05)。结论神经束膜吻合术治疗腕部尺神经损伤的效果优于神经外膜吻合术。     

周围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周围神经损伤的疗效。方法：从１９８８年３月至１９９５年６月，用显微外科技术修复周围神经损伤６８例共７８条神经，手术方法包括神经松解术、神经直接缝合术和神经移植术等。结果：经术后９个月～７年随访，优良率为８５．８９％。结论：临床资料证明：显微外科技术在神经损伤修复中有很大的优越性，能取得较满意的疗效。     

汶川地震致周围神经损伤14例诊治体会

目的：探讨战地条件下地震致周围神经损伤的诊断及治疗方法。方法：对地震致周围神经损伤14例进行总结回顾，观察战地条件下通过及时诊断并采用神经吻合术、修复术以及保守治疗等治疗方法对地震致周围神经损伤患者的疗效。结果：14例患者全部获得4周随访，所有患者神经损伤症状均有不同程度好转。结论：地震伤中周围神经损伤发生率较高，预防具有重要意义，战地条件下应因地制宜，结合患者伤情，早期给予有效治疗。     

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     

应用显微外科技术修复外周神经损伤

目的：分析应用显微外科技术在修复外周神经损伤中影响其疗效的因素及措施。方法：应用显微外科技术修复外周神经损伤105例120条神经，手术方法包括神经外膜缝合术、外膜束膜缝合术、神经移植术和神经松解术。结果：术后随访6-36个月，平均优良率78.7%。结论：应用显微外科技术对损伤神经的精确对合和及早修复能够提高疗效。     

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     

Surgical management for sciatic nerve injury

Objective:To summarize surgical treatments and their corresponding curative effects on sciatic nerve injuries.Methods:Surgical treatments on sciatic nerve injury were performed in 28 patients from January 1990 to July 2000.The treatments included neurolysis, neurolysis plus partial nerve anastomosis,nerve anastomosis and nerve transplantation.The curative effect was evaluated according to Sunderland criteria.Results:Of 28 cases, 22 patients were followed up with a follow-up period of 13 months to 5 years (average 30 months).Of 22 nerves, 7 were excellent ,5 good,7 fair and 3 poor ,with an excellence rate of 54.5%.Conclusions:The fair results of sciatic nerve injury are related to its structural character.Surgical exploration should be performed if nerve function does not recover 3 months after primary operation and if Tinel‘s sign and electromyogram show no signs of nerve regeneration.Electrophysiological monitoring in the operation is useful in electing surgical methods and predicting the results of nerve anastomosls .     

Hip and pelvic fractures and sciatic nerve injury

Objective:To investigate te influence of hip and pelvic fracture,especially acetanbular fracture complicated by sciatic nerve injury on clinical features and prognosis of sciatic nerve injury.Methods:From January 1987 to January 2000,17 patients(14 male and 3 female) who had hip and pelvic fractures complicated by sciatic nerve injury were treated with operative reduction and internal fixation and followed up from 10 months to 5 years.The average age was 38 years(ranging 23-56 years).The left extremities were involved in 11 patients and the right in 6.Twelve patients underwent primary exploration and neurolysis and 5 patients underwent secondary operation.Results:Preperativelys,8 patients were treated with large doses of oral narcotics to control their severe sciatic pain.Three of the 8 patients underwent patient-controlled analgesia and epidural analgesin.After operation,excellent and good rates of reduction and functional recovery of sciatic nerve were 94.1% and 88% respectively.Four patients still had sciatic pain and 2 patients failed to recover.Sciatic nerve function improved within 3-6 months after surgery in 11 patients.Conclusions:Hip and pelivic fractures can result in sciatic nerve injury,especially common peroneal nerve injury and prognosis is poor.Open reduction and internal fixation combined with nerve exploration and neurolysis should be used as early as possible for severe sciatic pain.     

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。     

Improvement in motor function after brachial plexus surgery

Motor functional recovery of 52 patients with brachial plexus surgery followed up for more than 2 years was evaluated. Fifty-eight surgical procedures were done, including autologous nerve grafting (38 cases), neurolysis (14 cases), and neurotization (6 cases). Overall results, evaluated according to the 0 to 5 formula of the Medical Research Council, were as follows: good, 58%; fair, 15%; and poor, 27%. Good results were evident in 58% of patients with nerve grafts and in 64% of those with neurolysis. In patients with neurotization, no good recovery and only one fair recovery were seen. Patients with open injuries showed good recovery, whereas the group with closed injury showed good recovery in only 48%. Patients with closed injuries caused by traffic accidents showed a worse recovery than those caused by other means. Patients with closed injuries and nerve grafting done within 3 months of injury or neurolysis within 6 months showed better recovery.     

Surgical management of trapezius palsy

BACKGROUND: Injury to the spinal accessory nerve in the posterior cervical triangle leads to paralysis of the trapezius muscle. The aim of this study was to determine the indications for nerve repair or reconstructive surgery according to the etiology, the duration of the preoperative delay, and specific patient characteristics. METHODS: Of twenty-seven patients with a trapezius palsy, twenty were treated with neurolysis or surgical repair (direct or with a graft) of the spinal accessory nerve and seven were treated with the Eden-Lange muscle transfer procedure. Lymph node biopsy was the main cause of the nerve injury. The nerve repairs were performed at an average of seven months after the injury, and the reconstructive procedures were done at an average of twenty-eight months. Nerve repair was performed for iatrogenic injuries of the spinal accessory nerve, within twenty months after the onset of symptoms, and in one patient with spontaneous palsy. Reconstructive surgery was performed for cases of trapezius palsy secondary to radical neck dissection, for spontaneous palsies, and after failure of nerve repair or neurolysis. The mean follow-up period was thirty-five months. The functional outcome was assessed clinically on the basis of active shoulder abduction, pain, strength of the trapezius on manual muscle-testing, and level of subjective patient satisfaction. RESULTS: The results were good or excellent in sixteen of the twenty patients treated with nerve repair and in four of the seven patients treated with the Eden-Lange procedure. Poor results were seen in older patients and in patients with a previous radical neck dissection. CONCLUSIONS: Good results can be expected from a repair of the spinal accessory nerve if it is performed within twenty months after the injury, as the nerve is basically a purely motor nerve and the distance from the injury to the motor end plates is short. Muscle transfer should be performed in patients with spontaneous trapezius palsy, when previous nerve surgery has failed, or when the time from the injury to treatment is over twenty months. Treatment is less likely to succeed when the patient is older than fifty years of age or the palsy was due to a radical neck dissection, penetrating injury, or spontaneous palsy.     

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％，     

Surgical outcomes of 111 spinal accessory nerve injuries

OBJECTIVE: Iatrogenic injury to the spinal accessory nerve is not uncommon during neck surgery involving the posterior cervical triangle, because its superficial course here makes it susceptible. We review injury mechanisms, operative techniques, and surgical outcomes of 111 surgical repairs of the spinal accessory nerve. METHODS: This retrospective study examines clinical and surgical experience with spinal accessory nerve injuries at the Louisiana State University Health Sciences Center during a period of 23 years (1978-2000). Surgery was performed on the basis of anatomic and electrophysiological findings at the time of operation. Patients were followed up for an average of 25.6 months. RESULTS: The most frequent injury mechanism was iatrogenic (103 patients, 93%), and 82 (80%) of these injuries involved lymph node biopsies. Eight injuries were caused by stretch (five patients) and laceration (three patients). The most common procedures were graft repairs in 58 patients. End-to-end repair was used in 26 patients and neurolysis in 19 patients if the nerve was found in continuity with intraoperative electrical evidence of regeneration. Five neurotizations, two burials into muscle, and one removal of ligature material were also performed. More than 95% of patients treated by neurolysis supported by positive nerve action potential recordings improved to Grade 4 or higher. Of 84 patients with lesions repaired by graft or suture, 65 patients (77%) recovered to Grade 3 or higher. The average graft length was 1.5 inches. CONCLUSION: Surgical exploration and repair of spinal accessory nerve injuries is difficult. With perseverance, however, these patients with complete or severe deficits achieved favorable functional outcomes through operative exploration and repair.     

医源性颈部神经损伤的修复

为探讨颈部手术所致医源性神经损伤的原因、预防、诊断和治疗，分析１９９３年～１９９６年８例因颈部手术致神经损伤的原因、诊治及结果。其中副神经损伤５例，臂丛神经损伤３例，均行手术治疗，治疗方法包括：神经松解、神经吻合、神经移植和神经移位。随访１１个月～３年，平均２４．５个月。结果表明，疗效优２例，良５例，差１例，优良率为８７．５％。认为，颈部手术易损伤神经，高度责任心和精细的手术操作是预防的关键；一旦确诊颈部神经损伤，应尽早手术修复     

上肢神经电损伤早期松解修复术后的临床疗效观察

目的:探讨上肢神经电损伤早期显微外科松解修复的临床疗效和肌电图评估结果。方法:自2013年4月至2019年12月,我们对8例肢体Ⅲ～Ⅳ度电击伤即上肢神经电损伤患者在伤后3个月内进行神经探查松解术。术前及术后2周、3个月行肌电图检查,术后6个月随访患肢感觉及运动功能恢复情况。结果:术后2周本组患者行肌电图检查,结果显示受...