周围神经损伤诊断与治疗进展

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1、中国修复重建外科杂志2006年第20卷第4期·319·周围神经损伤诊断与治疗进展朱家恺【摘要】目的综述周围神经损伤诊断和治疗的最新进展。方法复习国内外文献,并结合研究及临床经验,总结出周围神经损伤近几年取得的主要成果。结果全臂丛神经根性撕裂伤近年的进展有:健侧C7神经根通过颈椎前食管后方的通道直接移至患侧;吻合血管神经的股薄肌移植;MRI和CTM能早期诊断。对于臂丛神经上干或下干根性撕脱伤可用臂丛内神经移位术:即用尺神经部分束移位至肱二头肌肌支;健侧C7神经根选择性束组(保留前股前内侧)移位术或肱肌肌支移位至正中神经屈指肌束或骨间前神经。胸廓出口综合征多见于常保持头直视前方姿势

2、的人群中、易发生颈肌劳损者。放射性神经病尽早用肾上腺皮质素、抗凝药和高压氧治疗。结论虽然在周围神经损伤修复中已有很大进展,但在促进神经再生、功能重建方面尚需深入研究。【关键词】周围神经臂丛神经根性撕裂伤胸廓出口综合征放射性神经病先天性异常分支中图分类号:R62R651.3文献标识码:CRECENTPROGRESSINDIAGNOSISANDTREATMENTOFTHEINJURYTOTHEPERIPHERALNERVE/ZHUJiakai.DepartmentofOrthopedicandMicrosurgery,FirstAffiliatedHospital,SunYat-S

3、enUniversity,Guangzhou,510080,P.R.ChinaCorrespondingauthor:ZHUJiakai,E-mail:zhujk2001@yahoo.com.cn【Abstract】ObjectiveToinvestigatethelatestdevelopmentindiagnosisandtreatmentoftheinjurytotheperipheralnerve.MethodsTheliteratureathomeandabroadwasreviewed,andtheresearchfindingswithclinicalexperi

4、enceindiagnosisandtreatmentfortheinjurytotheperipheralnerveweresummarized.ResultsThetreatmentforthetotalbrachialplexusavulsioninjurywassuccessfullyperformedbytheextra-plexusnervetransfer.TheavulsionofthebrachialplexuscouldbedirectlyrepairedbythehealthyC7nerveroottransferthroughtheanteriorspi

5、nalapproach.Theforearmflexorscouldbereinforcedbytheneurovascularizedgracilistransplantation.MRIandCTMwerethebestmethodsofearlydiagnosisforthebrachialplexusinjury.Thepureupperorlowerrootavulsionofthebrachialplexusinjuriescouldberepairedbytheintra-plexusnervetransfer,whichinvolvedatransferofpa

6、rtoftheulnarnerveinthearmtothemotornerveofthebicepsforC5-C6avulsionofthebrachialplexus,andatransferofselectivefasciclesofthehealthyC7nerverootorbrachialmusclebranchtotheflexorsmusclefasciclesofthemediannerveoranteriorinterosseousnerve.Thethoracicoutletsyndromealwaysoccurredinthispositionwhen

7、theneckmusclefatigueoccurredinthetypistsorthegame-playersaftertheirlongstandinglookingforwards.TheC5andC6rootswererolledbythetendenofibrotictissueattheoriginofthescalenus.Afteraprocainblock,thesymptomsubsided.Radiationneuropathywasaseriesofpatholog