【摘要】 目的:研究预制血管化腓肠神经腓总神经多束组移植修复马尾神经损伤的临床疗效。方法:2006年3月至2008年12月我院接诊8例腰椎椎体爆裂性骨折患者，经手术、MR或神经肌电检测证实，确诊为马尾神经的不全损伤或完全性损伤。术中切除残存椎板2个节段，切开硬膜达蛛网膜下腔，先观察马尾神经粘连范围及程度，显微镜下细致将马尾间和马尾与蛛网膜间粘连分离，避免损伤马尾神经。90线在显微镜下缝合血管化腓肠神经腓总神经，多束组移植修复。进行长期临床疗效观察，行神经肌电检测及下肢会阴部功能观察。结果:临床平均随访时间2年3个月，5例患者会阴部感觉较术前有所恢复，大小便功能均较术前有不同程度的好转,且随时间延长逐步提高。陈旧性马尾神经损伤术后马尾神经残端痛症状较术前明显缓解，神经不全损伤后的异常放电神经过敏现象经神经松解手术后症状缓解。术后神经电生理检测股四头肌肌肉传导速度及潜伏期均有明显改善，2例患者股四头肌肌力有所增加。结论:采用血管化的腓肠和腓总神经与马尾神经吻合术，可以重建截瘫患者的部分感觉和大小便功能及少量的运动功能,缓解患者的疼痛症状，改善患者的生活质量。
【关键词】 神经移植; 马尾神经; 血管化; 多束组
Clinic study of repair cauda equina fibers with multisegmental
and revascularizal nerves graft
JIANG Chunzhi, WANG Liming, FEI Junliang, LIANG Bin(Department of Orthopaedics, The Affiliated Nanjing First Hospital of Nanjing Medical University, Nanjing 210006, China)
[Abstract] Objective: To study the clinic effect of repair cauda equine fibers with multisegmental and revascularizational nerves graft. Methods: From March 2006 to December 2008, date of 8 cases with lumbar burst fracture and dislocation were studied. The diagnosis of them was cauda equine incomplete injury or complete injury judged by operation or MRI or the electrophysiology check. Two remanet laminar segment was removed, and the dura was sptited into the cavitas subarachnoidealis. The conglutination of the cauda equine in area and degree was observed and the conglutination was separated by microscope. The cauda equine was repaired with multisegmental and revascularizational common peroneal nerves graft by microscope with 9 zero suture. The functional recovery following regeneration of cauda equine fibers was observed. Results: The average followup period was 2.25 years. The recovery of the perineum sense and the paraplegic uracratia and encorpresis was found in 5 patients in a certain extent. The cauda equine stump pain of the old injury can be revived by the nerve relieving incision and the nerve graft. From the electrophysio
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