吻合感觉神经的股前外侧穿支皮瓣在头颈外科中的应用

【目的】评估吻合感觉神经的股前外侧穿支皮瓣修复头颈肿瘤术后缺损的感觉重建效果。【方法】选取2013年5月至2015年5月应用吻合感觉神经的股前外侧穿支皮瓣重建头颈部肿瘤术后缺损患者35例,其中端端吻合27例,端侧吻合8例;神经外膜缝合9例,神经外膜加神经束膜吻合26例。术后4、8、16和24周监测皮瓣的感觉功能恢复情况。【结果】35例皮瓣均成活,患者面部外形恢复良好,供区伤口I期愈合。随访1～6个月,术后4周时皮瓣痛觉、触觉及两点辨别觉等有所恢复;术后24周皮瓣感觉功能均在S2以上,已达到皮瓣的保护性感觉,感觉恢复优良率为657．％;且皮瓣的色泽、质地、弹性良好。【结论】供区股外侧皮神经具有走形规律、表浅,皮瓣设计灵活方便,手术简便易行等特点;而受区面颈部感觉神经丰富,通过吻合感觉神经的游离股前外侧穿支皮瓣修复头颈部肿瘤术后缺损,可恢复皮瓣的感觉功能,对头颈部缺损修复有重要意义。     

经皮神经肌电刺激治疗周围神经损伤的疗效观察

目的：探讨经皮神经肌电刺激中运用设定的电参数治疗周围神经损伤的可行性及有效性。方法：采用TERESA-神经肌体仪（低频脉冲治疗仪）对23例周围神经损伤患者进行经皮神经肌肉电刺激治疗。治疗中应用设定好的刺激参数，观察受损神经功能恢复情况并进行治疗前、后肌电图对比分析。结果：23例桡神经、正中神经、尺神经、腓总神经及胫神经损伤患者，经1-2个疗程治疗后受损神经功能有明显恢复，神经纤维平均再生距离达21．3cm（2．03mm/d）。再生速度显著快于1-1．5cm/d的平均速度（P〈0．05）。其中21例（91．31％）感觉、运动功能达S3M3以上。肌电图检查发现经电刺激治疗后17例（73．91％）患者出现再生电位。结论：以设定的经皮神经肌电刺激治疗周围神经损伤可有效促进周围神经再生，改善受损的神经支配的肢体功能。     

手部创面的修复与术后康复

目的探讨手外伤创面修复及康复治疗方法，提高治疗水平。方法采用皮神经营养血管蒂皮瓣及感觉神经端侧吻合术急诊一期修复手外伤引起的软组织缺损结合康复治疗。36例患者，组织缺损面积平均为2．4cm&;#215;3．9cm。其中拇指、示指占63．4％。皮瓣可供面积3．0cm&;#215;5．0cnl。将神经断端与受区指神经作端侧吻合。结果皮瓣一期愈合32例，术后第1天出现静脉危象3例，经蒂部松解减压后愈合，手术失败1例，随访6个月，感觉恢复S2～S3级，运动良好。结论采用此治疗方法解决多种原因引起的手部软组织缺损并能较好恢复功能和感觉，满足现代创伤治疗理念，操作简单。     

手掌部皮肤撕脱伤吻合皮神经后感觉功能康复

应用显微外科技术吻合掌侧皮神经，重建手掌部皮肤感觉功能，吻合掌侧浅静脉，再建皮肤血液循环；术后通过系统的功能锻炼，24例手掌部逆行撕脱皮肤吻合皮神经后，感觉功能基本恢复。该术式一次修复成功，使逆行撕脱皮肤基本恢复抗压、耐磨及感觉灵敏的功能。     

周围神经端侧吻合的实验与临床研究进展

周围神经损伤是常见疾病,周围神经损伤后,其支配的远端肢体功能会受到严重影响。为使失神经支配的肢体恢复功能,长期以来,人们试图用多种方法对损伤神经进行修复。随着显微外科技术的发展和对神经损伤和失神经支配的神经生物学的深入了解,神经修复的效果有了巨大的进步。端端神经吻合是公认的神经完全断离的最有效的修复方法,     

利用显微外科技术修复周围神经损伤

目的 报道利用显微外科技术修复周围神经损伤的优势。方法 利用显微外科技术进行微创操作，共修复168例203条神经手术方法包括神经外膜缝合术、神经移植术和神经松懈术。结果 术后6个月～3年随访，优良率82.8％。结论 利用显微外科技术修复周围神经损伤能取得更好的疗效。     

手掌部皮肤撕脱伤吻合皮神经后感觉功能康复

应用显微外科技术吻合掌侧皮神经,重建手掌部皮肤感觉功能,吻合掌侧浅静脉,再建皮肤血液循环;术后通过系统的功能锻炼,24例手掌部逆行撕脱皮肤吻合皮神经后,感觉功能基本恢复。该术式一次修复成功,使逆行撕脱皮肤基本恢复抗压、耐磨及感觉灵敏的功能。     

电刺激定位法修复腕部正中神经损伤

目的：阐明神经束定位法在远端正中神经损伤修复中的作用。方法：选择４４例远端正中神经损伤病例，进行神经内束支分离，双极电刺激定位后束膜吻合，与１７例外膜吻合组对照。结果：束支分离定位法在远端正中神经损伤修复中的成功率为８８．６％，治疗组较对照组感觉恢复率有提高，但无明显差异（Ｐ〉０．０５），运动功能恢复率显著提高（Ｐ〈０．０１）。结论：神经内束支分离定位应用于远端正中损伤修复是可行的，并能提高其功能     

股神经损伤手术前后护理与康复治疗

目前周围神经损伤修复后的功能恢复仍不醛如人意。本科室自2005年3月2008年8月共收治股神经损伤78例,包括神经损伤、神经粘连及药物注射性神经损伤．均行显微外科手术治疗,术前、术后予以及时有效的护理及康复治疗,取得了良好效果。现将护理报告如下。     

拇指尺背侧逆行皮神经营养血管皮瓣修复拇指软组织缺损的临床研究

目的:探讨拇指尺背侧逆行皮神经营养血管皮瓣修复拇指软组织缺损的可行性及临床疗效。方法:于2004年3月-2008年12月应用拇指尺背侧逆行皮神经营养血管皮瓣修复拇指指端、指腹及指背软组织缺损25例,20例行皮瓣内皮神经与受区指神经行外膜缝合,重建受区感觉。结果:25例皮瓣中,1例皮瓣全部坏死,2例皮瓣远端部分坏死。20例吻合皮神经皮瓣后感觉均恢复至S3～S4,皮瓣血运、质地、弹性良好,不臃肿,外形好。结论:该皮瓣质地适中,操作简单,无需深部解剖,不破坏重要知名血管,手术创伤小,经吻合神经后皮瓣能恢复部分感觉,是修复拇指软组织缺损的理想方法。     

A (heat) shock to the system promotes peripheral nerve regeneration

Peripheral nerves are easily damaged, resulting in loss of motor and sensory function. Recovery of motor and sensory function after peripheral nerve injury is suboptimal, even after appropriate surgical repair. This is due to the slow rate of axonal elongation during regeneration and atrophic changes that occur in denervated Schwann cells and target muscle with proximal lesions. One way to solve this problem is to accelerate the rate at which the axons regenerate. In this issue of the JCI, Ma and colleagues show that this can be achieved in mice by overexpression of heat shock protein 27, providing hope for enhanced functional recovery in patients after peripheral nerve damage.     

Accelerating axonal growth promotes motor recovery after peripheral nerve injury in mice

Although peripheral nerves can regenerate after injury, proximal nerve injury in humans results in minimal restoration of motor function. One possible explanation for this is that injury-induced axonal growth is too slow. Heat shock protein 27 (Hsp27) is a regeneration-associated protein that accelerates axonal growth in vitro. Here, we have shown that it can also do this in mice after peripheral nerve injury. While rapid motor and sensory recovery occurred in mice after a sciatic nerve crush injury, there was little return of motor function after sciatic nerve transection, because of the delay in motor axons reaching their target. This was not due to a failure of axonal growth, because injured motor axons eventually fully re-extended into muscles and sensory function returned; rather, it resulted from a lack of motor end plate reinnervation. Tg mice expressing high levels of Hsp27 demonstrated enhanced restoration of motor function after nerve transection/resuture by enabling motor synapse reinnervation, but only within 5 weeks of injury. In humans with peripheral nerve injuries, shorter wait times to decompression surgery led to improved functional recovery, and, while a return of sensation occurred in all patients, motor recovery was limited. Thus, absence of motor recovery after nerve damage may result from a failure of synapse reformation after prolonged denervation rather than a failure of axonal growth.     

周围神经损伤后修复再生的研究进展

周围神经损伤是手显微外科的常见病,其治疗及功能恢复一直都是手显微外科的难题。周围神经缺损后如何促进再生修复,提高神经缺损的治疗效果,使患者功能恢复较好,一直是临床研究的重点、热点、难点。近年来随着基础研究的不断深入,人们对周围神经解剖及其再生微环境的认识,周围神经损伤治疗方法已经由药物治疗、手术治疗发展到基因工程等,为周围神经损伤患者的治疗提供了更好的治疗思路。本文就周围神经缺损后周围神经修复的方法作一综述。     

Musculocutaneous nerve injury after simulated freefall in a vertical wind-tunnel: a case report

We report a case of a skydiver with isolated musculocutaneous nerve injury, which occurred after prolonged positioning of the arm during simulated freefall in a vertical wind-tunnel. Musculocutaneous nerve injury is rare, and the mechanism of isolated injury to this nerve is not entirely understood. Isolated peripheral nerve injuries such as this easily mimic other injuries and can be difficult to diagnose. The skydiver complained of right arm weakness and numbness that began after training in a vertical wind-tunnel. Exam revealed weakness in right elbow flexion and forearm supination, and diminished sensation in the right lateral forearm. Electrodiagnostic testing revealed a decreased amplitude in the right lateral antebrachial cutaneous nerve sensory nerve action potential, and fibrillations and positive sharp waves in the biceps and brachialis muscles. By 5 months, the subject reported complete sensory and motor recovery. Physical and electrodiagnostic findings corresponded to the distribution of the musculocutaneous nerve. The mechanism of injury was likely the prolonged abducted, extended, and externally rotated position of the shoulder during simulated freefall. Although isolated nerve injuries are uncommon, unusual activities and physiologic demands of athletes can result in such injuries. It is important to be aware of peripheral nerve injuries to facilitate proper diagnosis and management.     

毫米波对周围神经损伤修复的影响

目的探讨毫米波对周围神经损伤修复的影响。方法将36只SD雄性大白鼠制作成左侧坐骨神经钳夹伤模型，随机分为治疗组和对照组。治疗组在神经损伤24h后，用毫米波辐射损伤部位，每周5次，每次30min，从运动功能、电生理、组织学等方面观察其对大鼠坐骨神经损伤修复的影响。结果治疗组在术后2，4，6周的运动神经传导速度均显著高于对照组；运动功能恢复时间明显短于对照组；电镜观察显示，对照组在术后2周的神经变性程度比治疗组严重，治疗组在术后4周和6周的神经再生数目和成熟度均优于对照组。结论毫米波能够促进周围神经损伤的修复和功能恢复。     

Chronic pain and sensorimotor deficits following peripheral nerve injury

Following upper limb peripheral nerve transection and surgical repair (PNIr) patients frequently exhibit sensory and motor deficits, but only some develop chronic neuropathic pain. Thus, the sensorimotor outcome of PNIr may be impacted by individual factors. Therefore, our aims were to determine if patients with chronic neuropathic pain (PNI-P) following PNIr (1) are distinguished from patients without pain (PNI-NP) and healthy controls (HCs) by the psychological factors of pain catastrophizing, neuroticism or extraversion, and (2) exhibit more severe sensorimotor deficits than patients who did not develop chronic pain (PNI-NP). Thirty-one patients with complete median and/or ulnar nerve transection (21 PNI-NP, 10 PNI-P) and 21 HCs completed questionnaires to assess pain characteristics, pain catastrophizing, neuroticism and extraversion and underwent sensorimotor evaluation. Nerve conduction studies revealed incomplete sensorimotor peripheral recovery based on abnormal sensory and motor latency and amplitude measures in transected nerves. The patients also had significant deficits of sensory function (two-point discrimination and vibration, touch, and warmth detection), sensorimotor integration, and fine motor dexterity. Compared to PNI-NP patients, PNI-P patients had higher vibration detection thresholds, performed worse on sensory-motor integration tasks, had greater motor impairment, and showed more impaired nerve conduction. Furthermore, PNI-P patients had reduced cold pain tolerance, elevated pain intensity and unpleasantness during the cold pressor test, and they scored higher on neuroticism and pain-catastrophizing scales. These data demonstrate that chronic neuropathic pain following PNIr is associated with impaired nerve regeneration, profound sensorimotor deficits and a different psychological profile that may be predictive of poor recovery after injury.     

纤维蛋白胶和医用OB胶联合几丁聚糖-胶原导管修复面神经损伤

背景：纤维蛋白胶和医用OB胶均能用于周围神经损伤的修复,但两种胶体的结构组成和作用原理完全不同。目的：对比分析纤维蛋白胶或医用OB胶联合几丁聚糖-胶原导管修复兔面神经损伤的效果。方法：制作中国大耳白兔右侧面神经下颊支损伤模型,随机数字表法分成3组：显微外科吻合组,将神经断端对位,作外膜原位吻合;纤维蛋白胶导管粘合组与医用OB胶导管粘合组分别采用纤维蛋白胶或医用OB胶粘合与显微外科技术吻合进行修复。术后16周进行大体观察、神经电生理检测、组织学观察、图像分析,评价神经再生恢复情况。结果与结论：几丁聚糖-胶原导管吸收明显,能抑制吻合口周围纤维结缔组织形成。3组神经肌肉功能恢复良好,口轮匝肌动作电位潜伏期和复合神经肌肉动作电位振幅（M波）检测结果差异无显著性意义（P〉0.05）,再生轴突恢复比相似（P〉0.05）,但轴突再生率不同,纤维蛋白胶导管粘合组、医用OB胶导管粘合组均高于显微外科吻合组（P〈0.05或0.01）,其中医用OB胶导管粘合组最高。说明胶原导管生物相容性良好,与纤维蛋白胶或医用OB胶联合应用修复损伤神经效果肯定,但纤维蛋白胶更适于神经损伤的手术操作。     

野百合碱诱导大鼠肺动脉高压模型的建立

背景：目前尚缺乏简单易行、实用、操作性强的肺动脉高压动物模型。目的：建立一种实用的注射野百合碱诱导的肺动脉高压动物模型。方法：采用一次性皮下注射野百合碱60mg/kg的方法制备SD大鼠肺动脉高压模型。结果与结论：野百合碱注射后第1,2,3,4周,大鼠平均肺动脉压明显升高,右心室肥厚明显。光镜下可见肺小血管肌化程度增强,相对中膜厚度增加,肺血管密度减少,以上症状均随野百合碱注射时间的延长逐渐加重。证实此方法建立的大鼠肺动脉高压模型造模成功。     

纤维蛋白胶和医用OB胶联合几丁聚糖-胶原导管修复面神经损伤

背景:纤维蛋白胶和医用OB胶均能用于周围神经损伤的修复,但两种胶体的结构组成和作用原理完全不同。目的:对比分析纤维蛋白胶或医用OB胶联合几丁聚糖-胶原导管修复兔面神经损伤的效果。方法:制作中国大耳白兔右侧面神经下颊支损伤模型,随机数字表法分成3组:显微外科吻合组,将神经断端对位,作外膜原位吻合;纤维蛋白胶导管粘合组与医用OB胶导管粘合组分别采用纤维蛋白胶或医用OB胶粘合与显微外科技术吻合进行修复。术后16周进行大体观察、神经电生理检测、组织学观察、图像分析,评价神经再生恢复情况。结果与结论:几丁聚糖-胶原导管吸收明显,能抑制吻合口周围纤维结缔组织形成。3组神经肌肉功能恢复良好,口轮匝肌动作电位潜伏期和复合神经肌肉动作电位振幅(M波)检测结果差异无显著性意义(P>0.05),再生轴突恢复比相似(P>0.05),但轴突再生率不同,纤维蛋白胶导管粘合组、医用OB胶导管粘合组均高于显微外科吻合组(P<0.05或0.01),其中医用OB胶导管粘合组最高。说明胶原导管生物相容性良好,与纤维蛋白胶或医用OB胶联合应用修复损伤神经效果肯定,但纤维蛋白胶更适于神经损伤的手术操作。     

脑卒中恢复期软瘫患者上肢周围神经损伤与运动功能的相关性

目的 通过神经电生理检查,评估脑卒中恢复期软瘫患者上肢周围神经损伤发生率,探讨上肢周围神经损伤与上肢运动功能之间的相关性,指导临床治疗及康复。方法 2015年12月至2019年10月,符合条件的脑卒中患者77例患侧上肢行运动神经传导、F波、皮肤交感反应(SSR)、针极肌电图(EMG)检查,采用简式Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。根据神经传导结果分为正常组和损伤组。结果 损伤组共41例(53.25%)。损伤组FMA-UE评分低于正常组(t = 2.193, P < 0.05);F波振幅和出现率降低( t > 2.002, P < 0.05),SSR振幅和潜伏期明显下降( t > 3.140, P < 0.01),但损伤组F波出现率、SSR潜伏期均处正常参考值范围内。神经损伤数与FMA-UE评分负相关( r= -0.858, P < 0.001);线性回归分析显示,尺神经、桡神经、肌皮神经振幅是FMA-UE评分的影响因素(B > 0.317, P < 0.05)。 结论 脑卒中恢复期患者患侧上肢出现软瘫后,有可能出现上肢周围神经损伤,且与运动功能恢复有关;应尽量避免、及时治疗周围神经损伤。