摘要
目的观察人脱细胞异体神经修复材料(hANG)修复上肢高位创伤性神经缺损的有效性。方法自2017年3月至2019年1月,采用hANG修复创伤性上肢神经缺损8例,其中男6例,女2例;年龄21~53岁,平均35.4岁。臂远端桡神经缺损2例,前臂段正中神经缺损4例,骨间后神经缺损1例,前臂段尺神经缺损1例;合并臂肌肉损伤2例,前臂肌肉损伤4例,合并肱动脉缺损1例,创面中至重度污染;神经缺损长30~60 mm,平均45 mm。均为急诊手术,先行骨折固定,修复肌肉组织,找出缺损神经远、近端,修剪至正常神经乳头,以hANG端端缝合进行桥接。术后随访18~40个月,平均30.6个月,观察移植物排斥反应,采用中华医学会手外科学会上肢部分功能评定试用标准评价修复效果。结果所有病例未出现移植物免疫排斥反应。5例伤口Ⅰ期愈合,2例创面无法闭合,Ⅱ期行游离植皮术后伤口愈合,1例患者术后10 d出现皮肤部分坏死,行局部皮瓣转移修复后伤口愈合。2例正中神经恢复良好,手指握拳及拇指对掌肌力Ⅳ级,感觉S_(3)^(+),1例骨间后神经恢复良好,伸拇伸指肌力Ⅳ级。根据中华医学会手外科学会上肢部分功能评定试用标准,优3例,可1例,差4例。结论在严格清创后,hANG可应用于急诊的高位创伤性神经缺损的修复,并可部分恢复神经功能。
Objective To observe clinical outcomes of the repair of traumatic nerve defects in the proximal upper extremities by human acellular nerve allograft(hANG).Methods Nerve defects in the upper extremities in 8 patients were repaired by hANG from March 2017 to January 2019.The patients were 6 males and 2 females with mean age of 35.4(21-53)years old.The nerve defects were 2 radial nerve in distal upper arm,4 median nerve in forearm,1 interosseous dorsal nerve and 1 ulnar nerve in forearm.All injuries were acute nerve injury.Two patients had combined injury of upper arm muscle,4 of forearm muscle and 1 of brachial artery defect.All wound were moderate to severe contaminated.The length of nerve defects was 30-60(mean 45)mm.The surgical procedures were fixation of fracture,repair of the muscle and discovery of the broken ends of nerve and to repair with hANG.The postoperative follow-up period ranged 18 to 40(mean 30.6)months to observe the local response of recovery.The efficacy was evaluated by the Upper Extremity Function Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association and Grading Standard of Muscle Strength.Results No graft rejection was observed in all cases.Primarily healing was in 5 patients.Delayed healing in 2 patients and free skin grafting was performed.Local flap transfer was performed to repair the wound in 1 patient who developed a skin necrosis 10 days after surgery.Two patients with median nerve defects had nerve function restored well.The strength of finger grip and thumb opposition muscle restored to grade Ⅳ and the sensory function had restored S_(3)^(+).The interosseous dorsal nerve in 1 patient restored well.The strength of extensor digitorum tendon had restored to grade Ⅳ.Based on the evaluation criteria for the upper extremity issued by the Hand Surgery of the Chinese Medical Association,3 patients was rated in excellent for function recovery,1 in fair and 4 in poor.Conclusion After throughout debridement,hANG can be applied in the repair of traumatic nerve defe
作者
张波
宫可同
张建兵
朱达克
ZHANG Bo;GONG Ketong;ZHANG Jianbing;ZHU Dake(Department of Hand and Microsurgery,Tianjin Hospital,Tianjin 300211,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2022年第2期139-143,共5页
Chinese Journal of Microsurgery
