【摘要】 目的观察大鼠桡神经移位修复股神经,重建股四头肌功能的效果,并应用C7神经根移位,通过长段神经桥接修复股神经,重建截瘫患者双下肢的部分功能。方法SD大鼠16只,随机分为两组。A组:将左侧桡神经切断,近端牵至锁骨下切口内,经吻合血管的坐骨神经进行桥接,一期修复同侧股神经;B组:行桡神经与桥接神经吻合,术后3个月再切断同侧股神经并与桥接神经吻合。观察指标为电生理、股四头肌湿重恢复率、肌纤维截面积恢复率、有髓神经纤维通过率及截面积恢复率。临床上应用C7神经根为动力神经源,将胫神经自小腿远端切断并向近端游离至臀部,应用带血管蒂的胫神经反转至颈部与C7神经吻合,待胫神经自颈部再生到臀部后,再将胫神经与股神经吻合来治疗2例截瘫患者。结果B组股四头肌湿重、肌纤维截面积恢复率均优于A组;两组有髓神经纤维通过率、截面积恢复率及肌肉复合动作电位波幅比较差异无显著性意义。1例随访41个月,左侧股四头肌肌力恢复至4-级,右侧3级;另1例随访24个月,双侧股四头肌肌力恢复至2-级。结论周围神经具有强大的再生能力。C7移位分期修复股神经可重建截瘫患者下肢的部分感觉、运动功能。更多还原

【Abstract】 Objective Based on investigating the results of brachial plexus nerve transfer to repair the femoral nerve in rats, C7 nerve root transfer to femoral nerve autograft to reconstruct the function of quadriceps femoris of paraplegia was designed and evaluated clinically. Methods 16 SD rats were randomized into 2 groups. Group A: the radial nerve of the left side was severed, and the proximal end of the radial nerve was transferred to the femoral nerve of the lower limb on the same side through the vascularized sciatic nerve bridging in one stage; Group B: the radial nerve anastomosed with the bridging nerve at first, then 3 months later the femoral nerve was sectioned, and the distal end of which anastomosed with the bridging nerve. Electrophysiology and histology including amplitude of compound action muscle potential, muscle wet weight, cross section areas were used to evaluate the effects at sixth month after operation. Furthermore, two patients with paraplegia were treated by the C7 nerve root transfer to reconstruct the function of quadriceps femoris. The C7 was sectioned at the distal of nerve root , and proximal end was used for motor nerve, the vascularized tibial nerve sectioned at the middle of the crus and dissected to the rump along the posterior of lower limb was reversed to the ipsilateral cervical incision through the tunnel and used for bridging nerve to anastomose with the proximal end of C7. When the nerve fiber regenerated into the hip through bridging nerve, the femoral nerve was sectioned and distal end anastomosed with bridging nerve. Results There was no significant difference between the two groups in the results of nerve regeneration and amplitude of compound action muscle potential, but group B was superior to the group A in muscle net weight and section area of muscle fiber. One case suffered paraplegia had already been repaired the double side femoral nerve by the method, after 41 months follow up, the muscle power of quadriceps was 4 grade on the right side and 3 grade on the left. The other was followed up for 24 months, the muscle power of quadriceps was 2 grade on both sides. Conclusion C7 nerve transfer to repair the femoral nerve through the vascularized tibial nerve bridging in two stages could reconstruct the movement and sensation function of lower limb of paraplegia.更多还原