不同吻合方式修复双侧指固有神经缺损疗效比较

Comparison effect of different methods on bilateral proper digital nerve injuries for repairing severed fingers

目的比较不同神经吻合方式修复双侧指固有神经缺损的临床疗效。方法选择70例双侧指固有神经缺损患者按照不同神经吻合方式分成A、B、C 3组：A组24例采用移植神经弓端侧吻合,B组26例采用移植神经弓双端侧吻合,C组20例采用移植神经直接桥接端端吻合。观察3组指关节自主活动度总和（TAM）、感觉恢复情况、两点辨别觉和不良反应发生情况。结果患者均获得随访,时间1~10个月。3组指关节TAM优良率比较差异无统计学意义（P〉0.05）。A组和B组远节指腹感觉明显高于C组（P〈0.05）,A、B两组比较差异无统计学意义（P〉0.05）。A组和B组两点辨别觉明显低于C组（P〈0.05）,A、B两组比较差异无统计学意义（P〉0.05）。3组患者伤口均甲级愈合,未出现伤口感染和皮肤软组织坏死。术后72 h出现血管危象A组1例、B组2例、C组1例,均在肌肉注射盐酸哌替啶＋静脉滴注肝素钠后缓解。B组2例术后4~6周用力握物时出现麻木和放射性疼痛等,术后6~12周疼痛自行消失。结论移植神经弓端侧吻合能够有效修复双侧指固有神经缺损,促进指腹感觉的恢复,效果优于移植神经直接桥接端端吻合。

Objective To compare the clinical effects of different methods on bilateral proper digital nerve injuries for repairing severed fingers. Methods A total of 70 patients with bilateral proper digital nerve injuries were divided into three groups according to different treatments,24 patients underwent nerve graft bow end-to-side neuroanastomosis（ group A）,26 patients underwent digital nerve bow end-to-side neuroanastomosis（ group B）,20 patients underwent nerve graft with end-to-end neuroanastomosis（ group C）,the sensation of finger plup,two point discrimination and motion of joints were evaluated. Results Follow up time was 1 ~ 10 months,the excellent rate of joint TAM had no statistically significant difference（ P〈0. 05）. The distal segment finger feeling of group A and group B was higher than that in group C（ P〈0. 05）,but there＇s no significant difference between group A and group B（ P〈0. 05）. The two-point discrimination of group A and group B was lower than that in group C（ P〈0. 05）,but there＇ s no significant difference between group A and group B（ P〈0. 05）. All wound of three groups cases were healed,no infection or soft tissue necrosis was found. Postoperative 72 h,1 case of vascular crisis occurred in group A,2 cases in group B,1 case in group C,all cases were alleviated after intramuscular injection of pethidine hydrochloride ＋ intravenous infusion of heparin sodium salt. Two cases of group B appeared felt numb and radioactive pain in 4 ~ 6 weeks after operation when squeezing the matter,and the pain disappeared in 6 ~ 12 weeks postoperation. Conclusions The nerve bow end-to-side neuroanastomosis is valuable method for repairing bilateral proper digital nerve injuries at the same time,which can restore sensation of fingers.