带蒂肌膜瓣重建神经外膜的临床研究

Reconstruction of epineurium with pedicled sarcolemma flap

目的 介绍对 18例 (2 2条 )周围神经显微松解、束间修复后神经外膜缺损 >5cm时用带蒂肌膜瓣重建神经外膜的手术方法。方法 周围神经SeddonⅡ类损伤 ,经 3～ 6个月保守治疗无效后 ,采用常规神经显微松解或神经束间修复 ,并确定神经干外膜的缺损范围后 ,选用邻近健康肌肉的肌外膜 ,形成带蒂肌膜瓣 ,包裹在外膜缺损段神经干上 ,用 9 0无损伤缝线将肌膜瓣两侧相互缝合呈管状 ,再将两端与神经外膜缝合。结果 术后随访 6个月～ 5.6年 (平均 3 2 .6个月 ) ,按 1954年英国医学研究所颁布的感觉、运动分级标准评定 ,优良率达到 77.3 %。结论 带蒂肌膜瓣重建神经外膜可改善损伤段神经血运 ,隔离神经束与周围瘢痕的粘连 。

ObjectiveTo reconstruct epineurium defect caused by neurolys is or interfascicular repair with pedicled sarcolemma flap. Methods18 cases (22 nerves) of Seddon II type nerve injuries were treated with neurolysis or interf ascicular repair. A segment of epineurium defect larger than 5 cm occurred. A pe dicle flap of sarcolemma from nearby normal muscle was harvested according to th e size of the defect and wrapped around the injured nerve segment to form a tube . The two ends of the sarcolemma tube were sutured to the corresponding epineuri um.ResultsAll the patients were followed for 6 months to 5.6 y ears (average 32.6 months). 77.3% of the cases were graded as good (Standard of British Medica l Research Council, 1954).ConclusionReconstruction of epineuri um with pedicl ed sarcolemma flap can improve blood supply of the injured nerve, avoid scar adh esion of the nerve to its investment, and provide preferable microenvironment fo r nerve regeneration as normal epineurium does.