可降解生物套管小间隙套接法修复周围神经损伤的临床观察

Clinical effect observation of biodegradable conduit small gap tublization repairing peripheral nerve injury

目的:观察可吸收生物套管小间隙套接法修复周围神经损伤的临床效果。方法:收集30例新鲜上肢周围神经损伤的患者,经过知情同意后采用随机数字的方法分为两组,各15例,试验组采用可降解的甲壳质生物套管进行套接法修复,对照组采取传统的神经外膜缝合修复。对术后的神经恢复情况进行临床观察,根据沈宁江和英国医学委员会推荐的评分方法,计算功能恢复的综合优良率,术后6个月进行电生理检查。结果:30例患者中28例得到随访,试验组和对照组各14例。套管套接组手术操作简单,平均缝合时间[(8.0±0.8)min]比传统神经外膜平均缝合时间[(10.0±0.6)min]缩短20%,套管套接组伤口如期愈合,未见排异反应或过敏反应及异常引流。术后6个月的电生理检测结果:生物套管套接组感觉神经传导速度恢复率77.37%,运动神经传导速度恢复率70.09%;传统神经外膜缝合组感觉神经传导速度恢复率61.69%,运动神经传导速度恢复率56.15%;感觉、运动神经恢复率的比较分别采用Fisher’s精确概率法,两组之间差异无统计学意义(感觉神经恢复率P=0.678,运动神经恢复率P=0.695)。神经修复后6个月的综合优良率显示:套管套接组优良率78.57%,传统神经外膜缝合组优良率28.57%,经Fisher’s精确概率法比较,两组差异有统计学意义(P=0.021)。结论:可吸收生物套管小间隙套接法修复周围神经损伤操作简单,临床效果明显好于传统的神经外膜缝合,具备临床替代神经外膜缝合的可行性。

Objective：To observe the clinical effect of biodegradable conduit small gap tublization to repair peripheral nerve injury.Methods：In the study,30 cases of fresh peripheral nerve injury in the upper extremities were recruited.After formally informed and obtaining the consent,the recruited patients were divided into the degradable chitin conduit tublization group（experimental group：15 cases） and traditional epineurial neurorrhaphy group（control group：15 cases）.Their nerve functional recovery conditions were clinically observed according to the standard score methods provided by SHEN Ning-jiang and British Medical Research Council.The excellent and good rates of the overall nerve functional recovery were calculated.The electrophysiologic study was carried out after 6 months.Results：Of the total 30 cases,28 were followed up,and there were 14 cases in the degradable chitin conduit tublization group and traditional epineurial neurorrhaphy group.The operation procedure was very simple,and the mean suture time [（8.0±0.8） min] was 20% shorter than that of the traditional epineurial neurorrhaphy group [（10.0±0.6） min].All the wounds in the degradable chitin conduit tublization group healed as expected without rejection、hypersensitive reaction or anomalous draining.Electrophysiology examination results after 6 months displayed that the sensory nerves conduction velocity recovery rate was 77.37 % of the normal value,and motor nerve conduction velocity recovery rate was 70.09% in the degradable chitin conduit tublization group.The sensory nerves conduction velocity recovery rate was 61.69% of the normal value,and motor nerve conduction velocity recovery rate was 56.15% in the traditional epineurial neurorrhaphy group.The exact propability methods was applied in the comparison of sensory and motor nerve conduction velocity recovery rate,and there was no statistically significant of two groups（sensory nerve conduction velocity recovery rate P=0.678;motor nerve conduction velocity recovery rate P=0.695）.The combinated functional recovery excellent and good rates after repair in the degradable chitin conduit tublization group were 78.57%,while 28.57% in the traditional epineurial neurorrhaphy group.The Fisher＇s exact probabilistic method was applied in the comparison of combinated functional recovery excellent and good rates,and there was statistically significant of two groups（P=0.021）.Conclusion：The operation procedure of the degradable chitin conduit tublization is very simple and the clinical reco-very effect is much better than that of the traditional epineurial neurorrhaphy.The biodegradable conduit small gap tublization methods to repair peripheral nerve injury has the possibility to substitute the traditional epineurial neurorrhaphy.