Ten Years’ Experience Using Tissucol in the Repair of the Brachial Plexus and Neighboring Nerves
Ten Years’ Experience Using Tissucol in the Repair of the Brachial Plexus and Neighboring Nerves
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使用 Tissucol 修复臂丛神经和邻近神经的十年经验
DOI：
10.1007/978-3-642-79346-2_15
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
C. Bonnard
中科院分区：
文献类型：
--
作者：
A. Narakas;C. Bonnard
从1980年11月开始的10年期间，在218名患者中使用了凝固血浆的圆柱形管连接了549个形成臂丛或靠近臂丛的干、索和神经（例如，脊髓副神经）的修剪残端。在少数情况下通过直接神经缝合获得重建，在绝大多数情况下通过神经移植和/或自体移植获得重建。对经典的神经束间修复技术进行了轻微修改，以减少中央和外周残端之间并置部位的结缔组织数量。必要时，使用9/0至11/0尼龙浅表留置缝线加强连接。对200例患者进行了肌力评估。平均年龄25.6岁，平均随访15.14个月。修复脊神经，躯干和脊髓产生。根据Highet（MRC）评分，64%的患者的结果优于M2+。75%的患者使用副神经和其他颈部运动支进行神经移位，而接受肋间神经修复的患者中只有57%得到改善。相比之下，84%的一般至良好的结果与修复各种神经丛，修复正中神经和尺神经是最不成功的。尽管对骨水泥和粘合进行了比较，但在如此复杂的手术中，不可能在统计学上证明一种方法优于另一种方法。操作时间肯定会有一定的增加，而且嫩芽更容易穿过连接点的界面，所以总的再生时间会短一些。然而，经过适当的后续行动，结果的质量是相同的。使用纤维蛋白封闭剂时失败率的减少可能要归功于参与研究的两位外科医生在另外10年的神经修复中获得的经验。
During a 10 year period, starting in November 1980, a cylindrical tube of clotted plasma was used in 218 patients to join the trimmed stumps of 549 trunks, cords and nerves forming the brachial plexus or lying close to it, eg, the spinal accessory nerve. Reconstruction was obtained by direct neurorrhaphy in a few cases and by neurotization and/or by autologous grafts in the vast majority of instances. The classical technique of interfascicular repair was slightly modified in order to diminish the quantity of connective tissue at the apposition site between the central and the peripheral stump. Whenever necessary 9/0 to 11/0 nylon superficial stay sutures were used to reinforce the junction. Muscular power was evaluated in 200 patients. The average age was 25.6 years and the average follow-up 15.14 months. Repair of spinal nerves, trunks and cords yielded. In 64% of the patients the results were better than M2+, according to the Highet (MRC) score. Neurotization using the spinal accessory nerve and other cervical motor rami led to positive results in 75% of the patients while only 57% of the patients who underwent intercostal nerve repair improved. By contrast, 84% of fair to good results with repair of various nerves close to the plexus, repair of the median and ulnar nerves being the least successful. Although a comparison between suturing and gluing was made, in such complex surgery it is not possible to demonstrate statistically the superiority of one method over the other. There was certainly a gain in operation time, and the sprouts crossed the junction's interface more easily so the total regeneration time was a little shorter. The quality of results are, however, the same after adequate follow-up. The reduction of failures witnessed when using fibrin sealant probably has to be attributed to the experience both surgeons involved in the study have gained during the additional 10 years of nerve repair.