吻合血管的尺神经转位治疗截瘫

目的：重建胸段脊髓横断致伤完全性截瘫患者的部分周围神经功能。方法：在４例截瘫病人将一侧的尺神经自腕部切断，以骨间前神经旋前方肌支吻接远端尺神经深支，取一桡神经浅支的分支与尺神经浅支吻接，自皮下隧分段游离尺神经至腋窝起始处，分离过程中保护尺侧上副血管。于皮下将尺神经及其尺侧上副血管引人侧胸壁隧道。显露胸背动，静脉，将尺侧上副血管与其行端端吻合。在臂部分离出阴部神经、股后皮神经和坐骨神经，用带筋膜蒂股

THE FUNCTIONAL RECONSTRUCTION OF PARAPLEGIA WITH ULNAR NERVE TRANSFER OF ANASTOMOSED VESSELS

To reconstruct partial peripheral nerve function in complete paraplegia patients with transverse injury of thoracic spinal cord. Methods: One side of the ulnar nerve was cut off in the carpal level, of ewhich the deep branch of the distal end was anastomosed with the pronator quadraturs muscle branch of anterior interosseous nerve and the superficial branch of the distal ulnar nerve was anastomosed with the superficial branch of radial nerve. The proximal ulnar nerve was dissected segmentally from the subcutaneous tunnel to it's originate in the axilla. The separated avasculartized ulnar nerve was conducted into the lateral thoracic wall tunnel. The thoracodorsal artery and venous were exposed and anastomosed end-to-end to superior ulnar collateral vessels. The pudendal nerve, posterior cuntaneous nerve of thigh and sciatic nerve were dissected in a hip incision. The ulnar nerve was bridged to the pudendal nerve with a reversed fascia pedical posterior cutaneous nerve of thigh. The dorsal hand branch of the ulnar nerve was anastomosisted to the sciatic nerve in an end-to-side manner. The branch of flexor carpi ulnaris muscle, which has been bridged by sural nerve, was anastomosed to the lumbosacral trunk. Results: 3 and 5 years follow-up of four patients got partial recovery of the pudendal neurological function and 1-2 degree recovery of sensory function of the pudendal, buttock and lower extremities. No significant claw hand was found in the donor site and the sensor in the hand improved to S3 and recovered to the original region. Conclusion: Ulnar nerve transfer of anastomosed vessels can reconstruct partial neurological function of complete transverse injury of the thoracic spinal cord.