正确认识周围神经断裂伤的修复方法

Methods of repair of peripheral nerve injuries

周围神经缺损的修复方法 ,目前仍以自体神经移植术较为常用。由于来源受限 ,供区受损 ,供求神经难以匹配 ,轴突再生需要跨越两个吻合口 ,从而影响疗效 ,因而需要开发其它途径。通过大量的实验研究和临床尝试 ,诸多学者推出了许多新的修复方法。本文只选其 7种 ,即受损神经自身延长端端缝合、神经端侧缝合、神经侧侧缝合、神经断端肌肉内埋入、骨骼肌桥架移植、去细胞异体神经移植和组织工程化人工神经等。笔者针对每种方法的设计机制以及存在的问题和对临床疗效的影响等方面进行讨论 ,目的是以求提高对各种方法的认识 ,使其在临床中得到正确选用。只有严格掌握适应证 。

At present time,auto neurotransplantation is frequently used in repair of defect of peripheral nerve. Because of lack of the source and donor site injuries,difficulty in obtaining well matched donor nerves,and axon regeneration needs to span two anastomotic points,a lot of new methods of repair have been developed. In this article,we introduced 7 methods including:streching and prolongation of the injured nerve follwed by end to end neurorrhaphy,end to side neurorrhaphy,side to side neurorrhaphy,implantation of nerve stump into muscle,skeletal muscle bridging transplantation,acellular nerve allograft and repair by tissue engineering,etc. The mechanism,problems and clinical effects were discussed. These methods should be strictly followed to improve the clinical effects.