3种缝合方法修复周围神经损伤的临床疗效观察

目的:应用显微外科技术修复周围神经损伤,评价外膜、束膜及外膜加束膜缝合法修复周围神经损伤的效果。方法:从2006年2月～2010年2月应用显微外科技术进行外膜、束膜及外膜加束膜等缝合法修复周围损伤神经152例,共168条神经,对有随访结果的80例共86条神经作总结。结果:经术后6月～4年的随访评定。优良率挠神经89.47%、尺神经79.41%、正中神经76%、绯总神经67%、坐骨神经50%、其中外膜、束膜、外膜加束膜缝合法的优良率分别是82.5%、88%、86%。总优良率为79.06%。经统计学处理不同缝合法疗效间无显着性差异(P>0.05)。观察不同修复时间:3个月内、3～6个月、6～12个月及12个月以上,各组间疗效具有显着性差异(P<0.01),<3个月和3～6个月内修复疗效明显优于其它2组。结论:临床资料表明、无张力无创伤的显微外科技术在周围神经损伤的修复中,有较大的优越性。但不同的缝合技术在本组中无显着性差异,说明应用传统对端外膜缝合在临床上目前仍是一种简单易行而实用的方法,同时应争取早期修复、尤其6个月内神经吻合具有非常重要的意义。

Assessment of Clinic Effects of Three Microsurgical Techniques in Perpheral Nerve Repair

Objective:Assess the clinic effects of microsurgical techniques included epineurial,perineurial, epineurial and perineurial neurorrhaphy and, with the exception of microsurgical techniques, the main factor of influencing effect. Methods:Form Fed.2006 to Fed.2010,152 cases(168 nerves)were treated with epineurial,perineurial, epineurial and perineurial neurorrhaphy. Among of these cases, there were 80 cases(86 nerves) with pro and postoperative follow-up result.The repair times between injury and surgery were divided into four groups: no more then 3 months, 3 to 6 months,6 to 12 months and more than 12 months.The surgical effect of different methods and different times were compared.Results: The follow-up examination was between 6 and 44 months after surgery. The excellent and good rates were shown that radial nerve was 89%,79.41% in ulnar nerve,76% in Median nerve,67% in fibular nerve and 50% in sciatic nerve,the excellet and good rates of epineurial,perineurial, epineurial and perineurial methods were 82.5%, 88% and 86%, respectively. The total excellent and good rate was 79.6%. No statistic significance was shown among different methods(P>0.05), but there were significant difference(P<0.01) among diffierent repair times,especially, the effects of the first two groups were better than those of others. Conclusion:Perineurial method of peripheral nerve repair is still a simple,reliable and practical technique at present.It is important to acquire early repair, especially within 6 months.