肋间血管神经转位脊髓神经根桥接治疗截瘫

Treatment for Paraplegia with Bridging Vascularied Intercostal Nerve to Spinal Cord Nerve Root

目的：恢复截瘫病人的部分功能。方法：损伤段脊髓显微松解、减压，将２ 条肋间神经及伴行动、静脉转位，以显微外科技术处理神经远段后将血管、神经部分植入桥接脊髓，并将肋间神经与神经根端端或端侧、侧侧吻合，必要时行小隐静脉与肋间动脉吻合动脉化的腓肠神经移植。结果：３１ 例病人经术后平均２－５ 年的随访，下肢肌力有明显恢复，可带支架扶双拐站立行走，大小便功能明显改善，即从Ｆｒａｎｃｋｅｌ 分级Ａ 或Ｂ 提高至Ｄ 级者９ 例；本体感觉功能恢复，大、小便功能有改善，但无明显功能性运动即从Ａ 至Ｂ、Ｃ 级者１７ 例；仅有感觉平面下降，双足本体深感觉恢复即从Ａ 至Ｂ者４ 例，无效１ 例。结论：该方法对伤后半年～１ 年截瘫无恢复，但ＭＲＩ 证实脊髓连续性尚存在的年青病人是有效的。

Objective :To reconstruct partial function for the later paraplegic patients .Method :After releasing and deco m pressing the injured part of the spinal cord microsurgically ,2 intercostal nerves with vessels ,of which the distal ends were han dled by microsurgical technique ,were transferred and bridged to the spinal cord nerve root,com monly anastom osed to cauda e quine .So metimes the sural nerve with small saphena vein grafted if necessary .Result :31 patients followed up for 1 ～3 years(av erage 2-5 years)postopratively ,regained the m uscular po wer of the lower extremities obviously and could stand up and walk a short distance with crutches and braces .Of the 31 cases ,9 cases had got obvious im prove ment of stool and urination function , means from Franckel○s classification A or Bto D,17 cases had the proprioception recovered com pletely ,the stool and urination function im proved slightly and no m ovable function ,m eans fro m Franckel○s A to B or C;4 cases only had descending of sensa tional plane and recovery of nou menon deep sensation oftwo feet ,m eans from Franckel○s Ato B;1 cases failed .Conclusion :The results show that this method is effective for the young patients w ho had no recoveries after 1/2 ～1 year since injury but the continuity of spinal cord was still present confirmed by MRI.