Value of nerve action potentials in the surgical management of traumatic nerve lesions
Value of nerve action potentials in the surgical management of traumatic nerve lesions
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DOI：
10.1097/00006123-199712000-00018
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发表时间：
1997-12-01
期刊：
影响因子：
4.8
通讯作者：
Richter, HP
中科院分区：
文献类型：
--
作者：
Oberle, JW;Antoniadis, G;Richter, HP
目的：目的：探讨术中电诱发神经动作电位（NAPs）在创伤性周围神经损伤（连续性神经损伤）手术治疗中的应用价值。方法：对64例76处连续性创伤性神经损伤患者，术中刺激并记录疑似损伤部位的整条神经的NAPs。76条神经（神经病变）中，功能不全43条，完全丧失33条。在功能完全丧失的病例（神经）中（n = 33），根据神经的显微镜特征和术中电生理测试结果进行外科手术（外部神经松解术、内部神经松解术或神经修复术）。在不完全丧失功能的病例（神经）中（n = 43），手术过程仅根据神经的显微镜方面进行，与术中电生理测试的结果无关。在43条功能不完全丧失的神经中，我们能够在41条（95%）病变部位记录到可重复的NAP，从而证明了该方法的高可靠性。在33条功能完全丧失的神经中，仅3条可记录到可重复的NAP。假设轴突损伤在再生中，我们没有对神经做任何其他处理，临床结果非常好（完全恢复）。在其余无NAP的神经中，24例显示神经口径移位（20例神经增厚，提示神经瘤连续性）。进行了移植手术，组织学评价显示神经性病变。然而，在6名没有NAP的患者中，没有明显的神经口径移位。打开神经外膜，进行内部神经松解术，显示连续的神经束。三名患者有很好的，三个有部分（但有用）recovery.CONCLUSIONS：在神经病变的连续性与神经功能的完全丧失，术中NAP能够检测axonotmetic损伤再生。因此，可以避免不必要的进一步外科手术。在光谱的另一端，没有可记录的NAP以及神经的口径移位（表明连续的神经瘤）可能有助于外科医生决定进行移植手术，而无需耗时的内部神经松解术。但我们的数据也有证据表明，并不是每一个没有NAP的连续神经损伤都需要移植。
OBJECTIVE: The goals of the study were to investigate the value of intraoperative electrically evoked nerve action potentials (NAPs) in the surgical treatment of traumatic peripheral nerve injuries (nerve lesions in continuity).METHODS: Sixty-four patients with 76 traumatic nerve lesions in continuity were investigated intraoperatively by stimulating and recording NAP from the whole nerve across the suspected lesion site. Among the 76 nerves (nerve lesions) were 43 with incomplete and 33 with complete loss of function. In cases (nerves) with complete loss of function (n = 33), the surgical procedure (external neurolysis, internal neurolysis, or nerve repair) was performed according to the microscopic aspect of the nerve and the result of the intraoperative electrophysiological testing. In cases (nerves) with incomplete loss of function (n = 43), the surgical procedure was performed solely according to the microscopic aspect of the nerve and independently from the result of the intraoperative electrophysiological testing.RESULTS: Of 43 nerves with incomplete loss of function, we were able to record reproducible NAPs in 41 (95%) across the lesion site, thus demonstrating a high reliability of the method. Of 33 nerves with complete loss of function, a reproducible NAP could be recorded only in 3. Assuming an axonotmetic lesion in regeneration, we did nothing else on the nerve with excellent clinical results (full recovery). Of the remaining nerves with no NAP, 24 showed a caliber shift of the nerve (in 20 cases a thickening of the nerve, suggesting a neuroma in continuity). A grafting procedure was performed, and the histological evaluation revealed a neurotmetic lesion. However, in six patients with no NAP, there was no clear caliber shift of the nerve. The epineurium was opened and an internal neurolysis performed showing fascicles in continuity. Three patients had good and three had partial (but useful) recovery.CONCLUSIONS: In nerve lesions in continuity with complete loss of nerve function, intraoperative NAPs are able to detect axonotmetic lesions in regeneration. Thus, unnecessary further surgical procedures can be avoided. On the other end of the spectrum, no recordable NAP together with a caliber shift of the nerve (suggesting a neuroma in continuity) may facilitate the surgeon's decision for a grafting procedure without a time-consuming internal neurolysis. But there is also evidence from our data that not every nerve lesion in continuity without a NAP needs to be grafted.