化学去细胞同种异体神经移植修复臂丛神经缺损23例

目的探讨化学去细胞同种异体神经移植修复人体臂丛神经缺损的疗效。方法 2004年2月-2009年3月应用化学去细胞同种异体神经移植修复我院臂丛神经损伤缺损的患者23例。共应用32根异体神经,长度为2-9(4.9±2.2)cm。术后定期对患者进行感觉、运动功能及肌电图、超声检查,评估疗效。结果 23例均获随访,随访时间33-94(71.82±18.50)月,临床疗效优良率为69.6%。按移植神经数目统计,优良率为68.6%。臂丛神经根性撕脱及神经移行处损伤修复效果差。疗效优组8例中移植长度3-7(4.6±1.64)cm,良组8例中移植长度5-9(6.67±1.61)cm,差组6例移植长度2-8(4.5±2.7)cm,三组移植神经长度具有统计学意义(P<0.05)。钝性伤18例中13例恢复优良,锐性伤5例中3例恢复优良。结论应用化学去细胞同种异体神经移植修复人体臂丛神经缺损具有良好的临床疗效。神经损伤部位、程度及异体神经移植长度对预后有影响。

Repair of brachial plexus defect with chemically extracted acellular nerve allograft in 23 cases

Objective To study the repair of brachial plexus nerve defect with chemically extracted acellular nerve allograft.Methods Brachial plexus nerve defect in 23 patients was repaired with chemically extracted acellular nerve allograft from February 2004 to March 2009 in our hospital.Thirty-two 2-9cm long（mean 4.9±2.2cm long） nerves were grafted.The patients were regularly followed up,during which their outcome was assessed by observing their sensation and motion function,EMG and ultrasonic examination findings.Results The patients were followed up for an average time of 33-94 months（mean 71.82±18.50 months）.The excellent and good therapeutic rate for chemically extracted acellular nerve allograft was 69.6% and 68.6% according to the grafted nerves.The effect of chemically extracted acellular nerve allograft was poor on root avulsion and transitional area injury of brachial plexus nerve.The longest allograft length was 7cm（mean 4.6±1.64cm） in 8 patients with an excellent outcome,9cm（mean 6.67±1.61cm） in 8 patients with good outcome,and 8cm（mean 4.5±2.7cm） in 6 patients with a poor outcome（P0.05）.Of the 18 patients with blunt injury,13 had a good outcome.Of the 5 patients with sharp injury,3 had a good outcome.Conclusion Chemically extracted acellular nerve allograft can repair brachial plexus nerve defect with a good clinical outcome.The location and severity of injury and the length of nerve allograft affect its prognosis.