周围神经损伤的外科处理

Surgical Treatment of Peripheral Nerve Injury

目的:探讨周围神经损伤的外科处理技术及手术疗效。方法:临床各种神经损伤病例共36例,其中采用神经松解术治疗25例,神经吻合术8例,取腓肠神经桥接手术3例。所有病例术后均行神经营养药物及康复治疗。结果:经2~3年随访,其中优21例,良5例,中5例,差5例,观察其中疗效评价为中、差者均为神经移植患者及部分神经吻合患者。结论:周围神经损伤诊断一经成立,原则上手术越早越好。处理臀盖下结构以及胸廓出口周围对医师技术要求较高。主张早期、足量使用神经营养药物并进行早期功能锻炼。

Objective: To explore the surgical technique and curative effect of peripheral nerve injury. Methods: Altogether 36 cases with every kinds of peripheral nerve injury were treated by operation. 25 cases were treated by lytic operation, 8 cases were treated by anastomosis, and 3 cases were treated by nerve transplantation with sural nerve. All cases were treated by nerve nutrition drugs and recovery therapy. Results: The follow-up ranged from 2 to 3 years. Excellent results were obtained in 21 cases, good in 5 cases, fair in 5 cases and poor in 5 cases. The cases with poor or fair results were mainly because of nerve transplantation or nerve anastomosis. Conclusions: As soon as the diagnosis of peripheral nerve injury was confirmed, operation should be begun immediately. The technique of control the structure under greatest gluteal muscle and surrending thorax exit is difficult to surgeon. To emphasize using nerve nutrition drugs earlier and full dose, earlier functional exercise also be emphasized.