CAJ | 학술논문

目的观察闭孔神经移位修复腰骶丛神经根撕脱伤的可行性及临床疗效.方法取15具成人尸体标本,显露双侧闭孔神经及腰骶丛神经根.测量闭孔神经从主干起始部至闭孔入口处的长度及其在闭孔入口处的横径和纵径,计算横截面积,并在高倍显微镜下计数有髓神经纤维数目.以相同方法测量并计算股神经相应指标.2002年1月至2007年9月,共为5例腰骶丛损伤患者进行闭孔神经移位术.行健侧闭孔神经经椎体前腹膜后通路移位与患侧股神经直接吻合4例,闭孔神经移位与同侧S1神经根直接吻合1例.结果闭孔神经的平均长度为(10.51±0.9)cm,横径(2.03±0.37)mm,纵径(2.78±0.29)mm,有髓神经纤维数目(5974±1996)根;股神经横径(3.79±0.58)mm,纵径(6.53±0.61)mm,有髓神经纤维数目(15 860±4350)根.术后3～7 d,所有患者供肢内收肌肌力均减弱至2～3级;术后3个月,4级2例,3级2例,2级1例(至术后1年时,内收肌肌力恢复3级).4例修复患侧股神经的患者,术后分别随访8个月～5年,股四头肌肌力4级2例,2级1例,1级1例;1例行闭孔神经移位与同侧S1神经根直接吻合的患者,术后11个月时小腿三头肌及屈趾肌肌力恢复至3级.结论闭孔神经可作为一个安全有效的动力神经源,用其修复腰骶丛神经根撕脱伤可获得满意疗效.
목적 관찰폐공신경이위수복요저총신경근시탈상적가행성급림상료효.방법 취15구성인시체표본,현로쌍측폐공신경급요저총신경근.측량폐공신경종주간기시부지폐공입구처적장도급기재폐공입구처적횡경화종경,계산횡절면적,병재고배현미경하계수유수신경섬유수목.이상동방법측량병계산고신경상응지표.2002년1월지2007년9월,공위5례요저총손상환자진행폐공신경이위술.행건측폐공신경경추체전복막후통로이위여환측고신경직접문합4례,폐공신경이위여동측S1신경근직접문합1례.결과 폐공신경적평균장도위(10.51±0.9)cm,횡경(2.03±0.37)mm,종경(2.78±0.29)mm,유수신경섬유수목(5974±1996)근;고신경횡경(3.79±0.58)mm,종경(6.53±0.61)mm,유수신경섬유수목(15 860±4350)근.술후3～7 d,소유환자공지내수기기력균감약지2～3급;술후3개월,4급2례,3급2례,2급1례(지술후1년시,내수기기력회복3급).4례수복환측고신경적환자,술후분별수방8개월～5년,고사두기기력4급2례,2급1례,1급1례;1례행폐공신경이위여동측S1신경근직접문합적환자,술후11개월시소퇴삼두기급굴지기기력회복지3급.결론 폐공신경가작위일개안전유효적동력신경원,용기수복요저총신경근시탈상가획득만의료효.
Objective To provide an effective and safe motor donor nerve for the treatment of lumbosacral plexus nerve root avulsion injuries. Methods The obturator nerve, lumbar plexus and sacral plexus on both sides were exposed on 15 cadaver specimens. The length of obturator nerve was measured from its origin to entrance of the foramen obturatum. The transverse diameter and thickness of the obturator nerve and femoral nerve on both sides were measured individually. The obturator nerve and femoral nerve of each specimen was cut into histological slice, and the amount of myelinated nerve fiber was counted respectively. There were five patients including 4 patients with traumatic lumbosacral plexus nerve root avulsion injuries and 1 patient with lumbar plexus nerve root injuries. The contralateral obturator nerve as motor donor nerve transferred through the retroperitoneal route and direct coaptation with the femoral nerve was performed in 4 cases, and ipsilateral obturator nerve was transferred to the S1 nerve root in 1 case. Results The length, transverse diameter and thickness of the obturator nerve was (10.5±0.9) cm, (2.03±0.37) mm and (2.78±0.29) mm individually. The transverse diameter and thickness of femoral nerve were (3.79±0.58) mm, (6.53±0.61) mm individually. The obturator nerve contained 5974±1996 myelinated nerve fibers and the femoral nerve contained 15 860±4350 myelinated nerve fibers. In 3-7 d after the operation, the muscle strength of adduction on the donor lower limber was decreased to grade 2-3. The functional recovery of muscle strength of quadriceps reconstructed by contralateral obturator nerve transfer recovered to grade 4 in 2 cases, grade 2 in 1 case and grade 1 in 1 case between 8 months to 5 years postoperatively. The muscle strength of triceps surae and finger flexor reconstructed by ipsilateral obturator nerve transferring to S1 nerve root recovered to grade 3 after 11 months postoperatively. Conclusion The contralateral or ipsilateral obturator nerve can be used as a new and effective donor nerve for transferring to repair the lumbosacral plexus nerve root avulsion injuries, and there is no obvious deficit on the function of donor lower limber adduction.