应用轴索修复技术治疗周围神经损伤的疗效分析

目的 评价轴索修复技术治疗周围神经损伤的临床疗效及应用前景。方法 采用特制保护液浸泡、液氮冷冻及断面修整、粘合与固定等轴索修复技术 ,对 12例周围神经 (13根神经 )损伤的患者进行轴索水平的修复，术后平均随访 9.7个月。结果 12例中， 4例行一期健侧 C 7移位术，术后 4～ 7个月神经再生达患侧胸锁关节或腋部，具备了二期行尺神经转位手术的条件； 5例行副神经移位于肩胛上神经，其中 3例术后 16个月冈上肌与冈下肌肌力达 3～ 4级 (按照 6级分类法 )， 2例术后 12个月神经功能有不同程度恢复； 1例行二期健侧 C 7移位手术 (尺神经移至正中神经 )，术后 4个月桡侧腕屈肌肌电图示神经再生； 1例行膈神经移位于肌皮神经，术后 15个月肌电图示神经再生； 1例行指神经修复，术后 3个月恢复保护性感觉。结论 轴索修复技术是一种有效的周围神经修复方法，具有一定的临床应用前景。

Outcome of the application of axonal repair technique for the treatment of peripheral nerve injury

Objective To evaluate clinical effects of using axonal repair technique (cell surgery) for the treatment of peripheral nerve injuries. Methods 12 patients with 13 injured peripheral nerves were treated with axonal repair technique of soaking the stumps of the nerve in a modified Collins fluid, freezing the stumps with liquid nitrogen, trimming the solidified stumps with a sharp blade, coapting the nerve with glue and two stitches of epineurium, so that the injured peripheral nerves were repaired at the axonal level. The postoperative evaluation was performed at an average of 9.7 months. Results In four of 12 cases operated upon with contralateral C 7 nerve root transfer(C 7 to ulnar nerve), regenerating axons had reached to the ipsilateral sternoclavicular joint or axilla at postoperative 4-7 months, so that the second stage of contralateral C7 nerve root transfer procedure could be performed. In five cases of which the accessory nerves were transferred to suprascapular nerves, the strength of supra-and infraspinatus of 3 patients had recovered to MRC 3-4 at postoperative 16 months, and that of the other two, to MRC 1-2 at 12 months. In one case undergoing the second stage procedure of contralateral C 7 nerve root transfer (ulnar nerve to median nerve), the flexor carpi radialis showed some nerve regeneration shown in EMG at postoperative 4 months. In one case of which phrenic nerve was transferred to the musculocutaneous nerve (the nerve graft 8 cm), the biceps showed some nerves regeneration shown in the EMG 15 months postoperatively. In one patient for whom two digital nerves were repaired, the protective sensation had recovered 3 months postoperatively. Conclusion Axonal repair technique is an effective and practical way for the treatment of peripheral nerve injury.