侧侧缝合法治疗周围神经损伤的临床应用初步报告

Treatment of peripheral nerve injury with side-to-side anastomosis

目的应用侧侧缝合法治疗周围神经损伤。方法选择10例不适宜施行常规修复方法的周围神经损伤病例,损伤至修复术的时间为1～10个月,平均4个月。将受损神经的适宜部位与相邻神经干并拢,纵行切开两神经相邻面的神经外膜和束膜1～2cm后,侧侧紧密对合,以9/0～11/0无损伤线侧侧缝合切开的束膜和外膜。手术前后所有患者均经过临床检查和肌电图检查。结果9例患者经3个月～3年随访,平均16个月。6例达到主要支配区的M3S3级,3例达到M2S3-级,供体神经术后功能无明显影响,有4例从M5S5级下降至M4S4级,3周～3个月后恢复正常。结论神经侧侧缝合法可作为一种不能用常规方法修复的损伤神经的补救性治疗方法。

Objective To determine the efficacy of side-to-side anastomosis in the treatment o f peripheral nerve injury.Methods Ten cases of peripheral nerve injury which could not be repaired by the routine methods were selected in thi s study by using the side-to-side anastomosis.The average time between injury to operation was 4months(1to 10months).The injured nerve trunk was kept abr east of neighbor donor nerve at suitable segment,the opposite epineurium and fascicle of two nerve were cut open 1-2cm until nerve fiber was seen.Two segments were clo sed together tightly and the side-to-side anastomosis was performed wit h9/0-11/0threads.Clinical and EMG e xamination were carried on in each case.Results Nine of ten cases were followed-up for 3months t o 3years,with an average of 16months.M3S3or b etter of their main nerve control area were found in 6/9c ases,and M2S3 - in 3/9.No obvious motion or sensory f unction loss was seen after the surgery,or the dec rease from M5S5down to M4S4of the don or nerve postoperatively re-covered in 3weeks to 3months.Conclusion Side-to-side anastomosis of peripheral nerve is a new remedy measure to treat those peripheral nerve injury which can not be treated by routine procedures.[