正中神经断裂伤晚期修复58例远期疗效

目的：通过对晚期神经损伤修复远期疗效观察，验证晚期神经损伤修复后能否获得满意的功能恢复。方法：对伤后１～１４年修复的５８例正中神经断裂伤，经１０年８个月长期观察，按国际统一标准评定疗效。结果：５８例中恢复优良３０例，占５１．７％。结论：伤后１年以上的晚期周围神经损伤的修复仍可获得较满意的恢复。     

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。     

前臂外侧皮神经移植加移位修复桡神经损伤

目的 探讨前臂外侧皮神经移植加移位修复前臂上段肘关节平面桡神经损伤的临床疗效.方法 采用前臂外侧皮神经移植加移位修复桡神经损伤患者11例,男9例,女2例,年龄20 ～ 52岁,平均34.5岁.受伤原因:电锯伤7例,磨具伤2例,挫裂伤2例.受伤部位:前臂上段肘关节附近,桡神经深、浅分支处,深、浅支均断裂伴缺损.急诊行神经修复术,术中将前臂外侧皮神经切断,近端神经移位与桡神经浅支远端吻合,远端作为供体切取神经段,游离移植桥接桡神经深支的缺损. 结果 11例患者术后随访12 ～24个月,桡神经浅支感觉功能恢复时间为4～9个月,平均5.4个月,其中5个月开始恢复功能9例,9个月开始恢复功能2例,虎口区两点辨别觉3 ～6 mm,平均4.5 mm.桡神经深支功能恢复平均时间7.6个月,6个月开始恢复4例,7个月开始恢复2例,8个月开始恢复5例.有9例肌力恢复至五级,平均时间19个月. 结论 前臂外侧皮神经移植加移位修复桡神经损伤应用同一神经既恢复了运动功能,又恢复了手虎口区感觉功能,为临床提供了一种修复桡神经损伤的新方法.     

儿童上肢晚期神经损伤的治疗

报告并评价儿童上肢晚期神经损伤的治疗效果。方法：报道１３岁以下儿童平均７岁上肢晚期神经损伤１５例２１条（正中神经８条，尺神经７条，桡神经５条，肌皮神经１条）。完全断裂９条，粘连、压迫１２条。损伤神经的处理时间为伤后１年至１４年（平均４年４个月）。采用神经外膜对端缝合术７条，神经松解术１２条，自体神经移植术１条，神经瘤对端缝合术１条。结果：１３例１８条神经随访１年至２３年６个月（平均４年９个月），优良率为６６．７％，尚有２７．８％病人恢复了保护性感觉。结论：本研究证实晚期神经损伤有修复价值，儿童病人能取得更满意疗效。     

外周神经损伤的显微外科修复

目的 探讨外周神经损伤显微外科修复的疗效及功能恢复.方法 应用显微外科技术对创伤造成神经开放性损伤的外周神经进行早期修复.对闭合性神经损伤系统治疗及观察1～3个月,无恢复征象给予手术探查及修复.结果 共修复外周神经135例,获随访93例,运动功能恢复达M,以上32.03%,感觉功能恢复达S3以上69.53%,除桡神经及股神经的运动功能恢复正常外,其它神经损伤修复只有感觉恢复,其中以肌皮神经恢复较好,S3以上占82.14%.结论 应用显微外科技术早期修复开放性外周神经损伤,有利于肢体感觉功能早期恢复.闭合性神经损伤系统治疗及观察一般不超过3个月,即神经损伤应在肌肉出现萎缩前进行修复.除了指神经近端毁损行神经转移替代取得较好疗效外,其它的神经行神经转移替代效果均不满意.     

面神经损伤临床治疗效果观察

目的　探讨临床上面神经损伤表情肌功能的修复时间及影响因素。方法　对外伤Ⅰ、Ⅱ期和腮腺恶性肿瘤切除面神经后即刻行耳大神经移植的患者 ,动态观察神经修复后不同时期表情肌功能恢复的效果及监测神经传导速度的变化。结果　外伤后Ⅰ期立即修复和外伤后Ⅱ期修复的患者 ,表情肌功能恢复时间分别为 2 2 .5周和31.2周 ,两者比较差异有显著性 (P <0 .0 1)。肿瘤切除后即刻行耳大神经移植的患者 ,表情肌功能恢复时间为 35 .2周 ,与外伤性即刻修复比较有显著性差异 (P <0 .0 1)。表情肌功能恢复时神经传导速度三者比较均无显著性差异(P >0 .0 5 )。外伤后超过 6个月行Ⅱ期修复者 ,表情肌功能未能恢复。结论　面神经损伤争取伤后即刻修复 ;即刻修复中 ,外伤性神经直接吻合比肿瘤切除后神经移植效果好 ;Ⅱ期修复时间越早效果越理想 ,外伤时间超过 6个月不适于单纯神经端端吻合治疗     

尺神经部分转位肌皮神经二头肌支治疗早晚期臂丛神经损伤

[目的]臂丛神经上中干损伤的修复治疗中肘屈曲功能是最为重要的.在已有的几种恢复肘关节屈曲功能的神经转位手术中,部分尺神经转位肌皮神经的手术(Oberlin' s method)是最新的方法.本报告应用Oberlin' s手术治疗早期和晚期臂丛神经上中干损伤的初步经验.[方法]5例臂丛神经上中干损伤的患者采用了Oberlin's手术进行伤肢肘关节屈曲功能的恢复治疗.患者平均年龄28岁,随访6～15个月.早期手术2例,分别伤后6个月和8个月手术.晚期病例3例,分别于伤后12～18个月实施手术.术后持续性进行肱二头肌、肘关节屈曲肌力、手内肌握力、尺神经支配区感觉测试.[结果]所有病例都恢复了肘关节的屈曲功能,都有3级以上的肱二头肌肌力恢复.2例早期病例术后1周内出现肱二头肌主动收缩,肘关节主动屈曲功能正常恢复时间平均6个月,平均肌力恢复4+级.3例晚期病例术后平均3个月出现肱二头肌收缩,肘关节主动屈曲功能正常恢复时间平均10个月,平均肌力恢复3+级.3例术后出现尺神经支配区感觉减退,1个月后自动恢复.[结论]Oberlin' s手术是治疗臂丛神经上中干损伤,快速有效恢复肘关节主动屈曲功能的有效方式.     

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。     

外伤性面瘫的早期手术治疗

目的 探讨外伤性面瘫手术时机和手术方法的选择。强调神经外瘢痕松解切除和严格遵守显微外科无创原则,结合神经损伤的形态特点。针对性选择优选用吻合神经方法的重要性。方法 1993年12月-1997年11月,收治外伤性面瘫病人7例。于伤后3-4个月采用显微外科技术进行面神经吻合及腓肠神经眼轮匝肌植入术进行修复。结果 术后随访6个月-2年,均获得了比较满意的面肌功能恢复。结论 外伤性面瘫,争取早日手术是成功的关键。方法宜首选面神经吻合,神经移植肌肉内植入术,对整复某些外伤后面瘫有其临床应用价值和适应证。     

腓肠神经移植修复桡神经深支损伤

目的 报道不同长度腓肠神经移植修复桡神经深支缺损的临床疗效。方法伤后3个月内的桡神经深支缺损2l例，缺损1～2cm者6例，2～5cm者12例，5～8cm者3例。采用相应长度腓肠神经移植修复。结果随访6个月至10年，平均13个月，21例桡神经深支功能均恢复较好，肌力均在Ⅳ～Ⅴ级。结论小于8cm长度的桡神经深支缺损，神经移植修复效果较满意。     

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     

侧侧缝合法治疗不完全性周围神经损伤的实验研究

目的： 种新的治疗不完全性周围神经损伤的方法一侧侧缝合法，并对其疗效进行初步的实验研究。方法：SD大鼠12只，双下肢随机分为实验侧和对照侧。将两侧腓总神经在相同部位以相同的力度钳夹损伤；实验侧将损伤的腓总神经远端与胫神经靠拢后，切开相邻面的束、外膜，互相侧侧缝合，对照侧不作进一步处理。3个月后，对神经的再生情况进行肌电图、组织学等检查。结果：实验侧腓总神经远端有良好的神经再生，再生的神经纤维质量与对照侧相比有显著差异（P＜0．05）。结论：不完全性周围神经损伤经侧侧缝合修复，可以获得较好的再生；侧侧缝合法是一种新的修复不完全性周围神经损伤的方法。     

Injury to the radial nerve caused by fracture of the humeral shaft:Timing and neurobiological aspects related to treatment and diagnosis

The radial nerve may not function in association with fractures of the humeral shaft. There are various opinions about the causes and treatment. We report a case of complete rupture of the radial nerve after a fracture of the proximal shaft of the humerus. The nerve injury was treated with grafting and TENDON transfer. Here we discuss diagnoses and treatments including neurobiological aspects of nervous regeneration. We suggest that electrodiagnostic examination after a radial nerve palsy caused by a humeral fracture is done 5–6 weeks after injury and that nerve repair and reconstruction should be done within two, and not later than three, months after injury.     

周围神经损伤的再手术治疗

目的：探讨周围神经损伤的再手术治疗的方法和疗效。方法：对167例周围神经损伤手术疗效不佳的病人进行再手术治疗，手术方法包括单纯松解术，神经松解 部分吻合术，重新吻合术和神经移植术，根据英国医学研究院颁布的感觉，运动分级标准评定疗效。结果：本组125例获随访，随访时间10个月-7年，平均28个月，共142条神经中功能优52例，良45例，可23例，差22例，结论：对于初次吻合后疗效不佳的周围神经损伤，应尽早积极地再次手术探查，术中电生理监测对决定手术方式及预计术后神经功能的恢复情况有较大的帮助。     

Radial nerve repair using an autologous denatured muscle graft: comparison with outcomes of nerve graft repair

Summary Background. The efficiency of denatured muscle grafting in nerve repair has been confirmed in experimental models and animals. The first clinical trials to repair digital nerves and mixed sensory-motor nerves were encouraging regarding sensory recovery but motor recovery was poor, probably because of delayed repair. We present the functional outcome of repair of motor nerves using denatured muscle graft and compare the results with those using standard nerve graft techniques. Methods. This prospective study included 9 radial nerve defects repaired with denatured muscle grafts and 23 radial nerve defects repaired using nerve grafts. Missile induced nerve injury, mid-arm level of lesion, a nerve gap smaller than 6 cm, and a preoperative interval of less than 5 months were characteristics shared by all patients. None of the patients had concomitant vascular injury, severe scarring, or significant soft tissue damage in the region of nerve repair. Motor recovery was estimated with 0–5 points, at least 4.7 years after surgery, according to the BMRC scale. Results. A successful outcome (≥M3) was achieved in 7 out of the 9 patients treated using a muscle graft and in 21 out of the 23 patients treated using nerve grafts (P > 0.05). Excellent recovery and the clinically significant re-establishment of thumb extension (M5 grade) were never achieved in the patients treated using muscle grafts. The average motor score was significantly better in patients treated with nerve grafts than in those who received muscle grafts (3.8 ± 0.9 and 3.2 ± 0.8; P = 0.035). With the patients who received muscle grafts, an inverse correlation existed between motor recovery and the length of the nerve gap (P = 0.017). Conclusions. Denatured muscle grafts can be useful for bridging short radial nerve defects, but the quality of recovery is significantly worse than after nerve graft repair. Even if relatively short nerve defects are bridged with denatured muscle grafts, the outcomes correlate inversely with the length of the gap.     

Sciatic nerve regeneration in the rat. Validity of walking track assessment in the presence of chronic contractures

The ability of the walking track assessment of sciatic nerve function to correlate with results of a nerve repair has been well documented following acute nerve injury and after recovery of the nerve following nerve repair. The long-term effects of partial denervation upon the lower extremity of the rat include the development of chronic contractures due to residual partial muscle paralysis and imbalance. The present study evaluated the ability of the walking track technique to portray accurately the walking pattern in animals following chronic contracture as a result of sciatic nerve repair. Animals 18 months and 24 months after sciatic nerve repair were found to have morphometric analysis distal to the repair that was not statistically significantly different from normal. However, the walking track assessment was inadequate at twenty-four months due to the development of clawing, interphalangeal joint contractures, and ankle inversion or eversion with or without dorsiflexion. The presence of these chronic deformities invalidated the walking track as an appropriate assessment technique for long-term assessment of nerve function following nerve repair.     

联合尺神经束支和臂丛外神经移位治疗臂丛损伤

目的 观察联合尺神经束支和臂丛外神经移位治疗臂丛损伤的临床效果.方法 臂丛损伤6例,其中单纯上干损伤4例;上中干为主,合并下干部分损伤2例.伤后平均2.8个月接受手术.术式包括尺神经部分束支转位至肌皮神经肱二头肌肌支,膈神经或者副神经斜方肌支转位至肩胛上神经,桡神经肱三头肌长头肌支转位修复腋神经肌支.用肱二头肌、岗上肌和三角肌肌力,肩外展和上举角度,尺神经功能损失等指标对手术方式和效果进行评估.结果 6例中5例得到随访,平均随访时间18个月,肱二头肌均在术后3～4个月开始恢复肌力.随访时间18个月以上的4例屈肘M_4~+～M_5;随访时间4个月的1例屈肘M_3~+.其中3例行外展功能重建,单用膈神经修复的病例上臂可上举至180°,外展肌力M_4~+;联合副神经和肱三头肌长头肌支修复的病例上肢可外展90°,肌力M_4~-;单用副神经修复的病例上肢可外展80°,肌力M_3~+.3例手部握持力与术前相同,2例增强.4例手部尺神经供区功能无明显影响,1例小指掌侧皮肤感觉减退,第一骨间背侧肌萎缩.结论 尺神经部分束支转位修复肱二头肌支可以有效的恢复臂丛损伤后屈肘功能;用膈神经修复肩胛上神经可能取得更好的肩外展和上举效果;本组臂丛下干部分损伤的病例受伤均在3个月内,采用此术式同样恢复了肱二头肌功能,未加重原有的手功能障碍.     

Superficial Peroneal Nerve to Deep Peroneal Nerve Transfer With Allograft Conduit for Neuroma in Continuity

The anterior approach to the ankle for surgery can result in injury to the superficial peroneal nerve, resulting in a painful neuroma and significant patient morbidity. A paucity of data is available evaluating the role of the superficial peroneal nerve to deep peroneal nerve transfer as a method of treatment of neuromas in continuity after ankle arthrodesis. We describe 11 patients who underwent nerve transfer with nerve allograft and conduit repair to treat recalcitrant painful neuromas after ankle arthrodesis. At a mean follow-up period of 31 months, the mean visual analog pain scale score had improved from 7.9 preoperatively to 2.45 postoperatively (p?<?.0001). These data suggest that nerve transfer with a nerve allograft can provide significant clinical improvement for painful neuromas of the peripheral nerves at the ankle.