神经侧侧吻合在治疗高位周围神经损伤中的意义

Significance of side-to-side anastomosis in repairing the high-level peripheral nerve injury

目的 探讨神经侧侧吻合方法在治疗高位周围神经损伤中的意义。方法 臂丛神经损伤者在上臂中上段行尺神经、正中神经相邻面侧方切开外膜、束膜后相对缝合。上臂神经损伤者在损伤部位以远处行受损神经与相邻正常神经的侧侧吻合。坐骨神经出口处腓总神经损伤者在大腿下段坐骨神经的腓总神经和胫神经分出处以上2～5cm，于坐骨神经内将腓总神经和胫神经侧侧缝合。结果 本组10例患者均得到术后1．5～4年（平均2．5年）的随访，受损神经支配区的感觉和运动功能恢复在臂丛神经损伤者为M2-3，S3，在上臂神经损伤者为M3S3，在腓总神经损伤者为M3-4S4，而供体神经支配区功能未受影响，所有病例对功能恢复效果均满意。结论 神经侧侧吻合方法是有效的治疗高位周围神经损伤的方法。

Objective To evaluate the efficacy of the side-to-side anastomosis in repairing the high-level peripheral nerve injury. Methods Using traditional methods to repair the peripheral nerve injury. If it is very difficult to repair, don＇ t treat it. To the brachial plexus injury, the opposite epineur/um and fascicle of the ulnar nerve and median nerve were cut open and then sutured respectively with 9/0-11/0 threads at the middle-superior segment of the upper arm. To the nerve injury at the upper arm, side-to-side anastomosis was performed distal to the nerve injury. To the injury of common peroneal nerve in the outlet of pelvic, side-to-side anastomosis of the common peroneal nerve and tibial nerve was performed at 2 - 5cm proximal to the branching of sciatic nerve. Results All the 10 cases were followed up for 1.5 to 4 years with an average 2.5 years. The function of injured nerve in the main control area recovered to M2_3S3 in patients with brachial plexus injury, M3S3 in nerve injury at the upper arm and M3_4S4 in the common peroneal nerve injury. All the patients expressed their satisfaction with the efficacy. Conclusion Side-to-side anastomosis of peripheral nerve is a effective measure to treat high-level peripheral nerve injury.