| 摘要: |
| 目的 探讨修复双侧指固有神经急性损伤的手术新方法。方法 2009年2月至2012年8月收治双侧指固有神经急性损伤患者56例，其中20例采用神经移植神经弓式双端侧吻合，术中游离修剪神经断端，将远端尺、桡侧指固有神经先吻合，形成远神经弓，再将近端尺、桡侧指固有神经吻合，形成近神经弓；测量两神经弓间距，取直径相近的前臂外侧皮神经，平分为两段，分别于神经弓的尺、桡侧开窗式端侧吻合。20例采用神经移植端-端吻合，16例采用直接端-端吻合。结果 术后创面均一期愈合，无一例患指发生血循环障碍。50例获随访，随访神经3~12个月。双端侧吻合组18例，指感觉测定为S3~S4级，平均S3+级，高于其他两组（P=0.024）；两点分辨觉为（5.2±0.7）mm，小于其他两组（P=0.037）；指各关节活动参照TAM评定：优14例，良3，可1例，3组指关节活动差异无统计学意义（P=0.914）。神经移植端-端吻合组19例，指感觉测定为S1~S3+级，平均S2级；两点分辨觉为（7.2±1.4）mm。直接端-端吻合组13例，指感觉测定为S3~S4级，平均S3级；两点分辨觉为（6.3±0.8）mm。结论 神经弓式双端侧神经吻合可修复指固有神经急性损伤，指感觉恢复快，能有效恢复指腹灵敏性，相关结论仍有待大样本研究证实。 |
| 关键词: 端侧神经吻合术 指固有神经 急性损伤 修复外科手术 |
| DOI：10.3724/SP.J.1008.2014.00149 |
| 投稿时间：2013-09-08修订日期：2013-11-01 |
| 基金项目:江苏省科技计划重点资助项目（BS2007054），南京军区科技创新重点资助项目（07Z028）. |
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| Arched nerves of double end-to-side neuroanastomosis for repairing bilateral acute proper digital nerve injuries |
| JIANG Qi-ting1*,WANG Yu2,YANG Li-na1,JIANG Zhi-wei3 |
(1. Department of Hand Surgery, Zichen Hand Surgery Hospital of Chaohu, Chaohu 238000, Anhui, China;
2. Shenyang Research Institute of Hand Surgery, Affliated Central Hospital of Shenyang Medical College, Shenyang 110024, Liaoning, China;
3. Research Institute of General Surgery, Nanjing General Hospital, PLA Nanjing Military Area Command, Nanjing 210002, Jiangsu, China
*Corresponding author.) |
| Abstract: |
| Objective To explore a new method for repairing bilateral acute proper digital nerve injuries. Methods From Feb. 2009 to Aug. 2012, 56 patients with bilateral acute proper digital nerve injuries were admitted to our center, with 20 undergoing double end-to-side neuroanastomosis. During operation, the injured digital nerve was excised, and then the bilateral distal ends and proximal ends were stured, consequently forming the distal and proximal nerve bows. A cutaneous antebrachⅡ lateralis nerve was freed and obtained from the homolateral forearm, and then was equally divided into 2 parts to bridge the 2 nerve bows. Twenty patients underwent nerve graft with end-to-end neuroanastomosis, and the rest 16 patients underwent direct end-to-end neuroanastomosis. Results All the patients achieved primary healing of wound after operation, with no circulation disorders. A total of 50 patients were followed up for 3-12 months. In double end-to-side neuroanastomosis group, 18 patients were successfully followed up, with the average sensation measurement being S3+, which was significantly higher than those of the other 2 groups(P=0.024). The average result of two point discrimination was (5.2±0.7) mm, which was significantly lower than those of the other 2 groups(P=0.037). According to TAM scales, the results of finger joint motion were excellent in 14 cases, good in 3 cases and fair in 1; and there were no significant differences in the motion of joints between the 3 groups (P=0.914). In nerve graft with end-to-end neuroanastomosis group, 19 patients were successfully followed up; the average result of sensation measurement was S2 and the average result of two point discrimination was (7.2±1.4) mm. In direct end-to-end neuroanastomosis group, 13 patients were successfully followed up; the average result of sensation measurement was S3 and the average result of two point discrimination was (6.3±0.8) mm. Conclusion The arched nerves of double end-to-side neuroanastomosis can be used for repairing bilateral acute proper digital nerve injuries, which can quickly restore the sensation of fingers, but the related conclusion needs further verification with large sample studies. |
| Key words: end-to-side neuroanastomosis proper digital nerve acute injury reconstructive surgical procedures |
