副神经损伤的诊治(附17例报告)

Treatment of the Spinal Accessory Nerve Injury:Report of 17 Cases

目的 :探讨颈部副神经损伤的原因、预防、诊断、治疗及各种治疗方法的选择。方法 :分析 17例副神经损伤的原因、诊治和结果。 16例行手术治疗 ,治疗方法包括 :神经松解 ,神经吻合 ,神经移植 ,神经移位。结果 :长期随访 17例病人 ,时间 11个月～ 3年 ,平均 15个月 ;结果表明疗效优 7例 ,良 7例 ,差 3例 ,优良率 82 %。结论 :颈部手术误伤是副神经损伤的主要原因 ,高度责任心和精细的手术操作是预防副神经损伤的关键 ,一旦确诊神经损伤 ,应尽早手术探查 ,根据具体伤情选择合适的方法修复治疗 ;神经本身的损伤程度和及早的手术治疗是神经功能恢复质量的关键。

Objective:To investigate the causes,prevention,diagnosis,treatment and selection of treatment methods.Methods: To analyze the causes,diagnosis,treatment and results of 17 cases with spinal accessory nerve injury.And 16 caes were operated on,including neurolysis,repaired by direct suture,nerve graft and nerve transposition.Results:After 11 months～3 years(15 months) follow up of the 17 cases,the results were excellent in 7 cases,good in 7 cases,poor in 3 cases.And the percentage of satisfaction was 82%.Conclusions:Iatrogenic injury to the nerve after a surgical procedure in the posterior cervical triangle is one of the most common causes of the spinal accessory nerve injury,high responsibility of surgeons and precise manipulation during operation is the key to prevent the nerve injury.Surgical exploration should be considered as early as possible once the diagnosis is confirmed,and appropriate methods should be selected according to the injury conditions.The nerve injury it self and the earlier operation are key to the functional restoration of the spinal accessory nerve.