|腰骶丛神经损伤的手术探查结果分析 & 健侧闭孔神经移位修复腰骶丛神经撕脱伤的解剖学观察|
|关键词||腰骶丛 创伤与损伤 临床分型 腰骶丛损伤 创伤 神经移位 闭孔神经|
|其他题名||Surgical Exploration of Lumbosacral Plexus Nerve Injury & Applied Anatomy Study of the Contralateral Obturator Nerve Transfer to Repair Lumbosacral Plexus Nerve Avulsion|
结果：健侧闭孔神经经椎体前腹膜后移位，与相应对侧股神经均能直接吻合，且有1~2 cm 的重叠。闭孔神经的平均长度为(10.9±0.5)cm，横径(1.78±0.22)mm，纵径(2.49±0.22)mm，有髓神经纤维数目(5867±1136)根；股神经横径(4.07±0.39)mm，纵径(5.57±0.42)mm，有髓神经纤维数目(15387±1126)根，闭孔神经的神经纤维数目约为股神经纤维数目1/3。
Part 1: Surgical Exploration of Lumbosacral Plexus Nerve Injury
Objects: To analyze the location and acteristics of lumbosacral plexus nerve root injury.
Methods: From November 2004 to September 2015, there were 92 patients suffered with lumbosacral plexus nerve root injury underwent surgical exploration in our department, including 68 males and 24 females, with the average age of 29 years old (from 4 to 62 years old). The average delay period from injury was 7.8 months (form 1 to 48 months). The lumbosacral plexus nerve injury was classified into six clinical types according to preoperative clinical manifestations and results of physical examination and the amount of nerve root injury intraoperative. The location and acteristics of nerve root injury of each clinical type were analyzed.
Result: There are 5 cases with total lumbosacral plexus nerve root injury, among which 100% nerve root injury level located intraspinal (2 rupture and 2 avulsion and 1 both happened); there were 7 cases with lumbar plexus and upper sacral plexus nerve root injury, among which 85.7% (6/7) nerve root injury located in the spinal canal; there were 32 cases with sacral plexus nerve root injury, among which 65.6% (21/32) nerve root injury located in the spinal canal; there were 25 cases with upper sacral plexus nerve root injury, among which 76% (19/25) nerve root injury located in intro-pelvic or pelvic sacral foramina, and all of them were distraction injury; there were 11 cases with lower sacral plexus nerve root injury, among which 63.6% (7/11) nerve root injury located in intro-pelvic or pelvic sacral foramina; there were 12 cases with lumbar plexus nerve root injury, among which 75% (9/12) nerve root injury located in intro-pelvic or pelvic foramina, and all of them were distraction injury or rupture.
Conclusions: Total lumbosacral plexus, lumbar plexus and upper sacral plexus, and sacral plexus nerve root injury mainly located in the spinal canal, while upper sacral plexus and lower sacral plexus as well as lumbar plexus nerve root injury mainly located in intro-pelvic or pelvic foramina or retroperitoneal.
Part 2: Applied Anatomy Study of The Contralateral Obturator Nerve Transfer to Repair Lumbosacral Plexus Nerve Avulsion Injuries
Objects: To provide anatomic basis for clinical application of the contralateral obturator nerve transfer to repair the lumbosacral plexus nerves avulsion injuries.
Methods: Lumbosacral plexus on both sides of 10 adult cadaveric specimens were exposed. The length of obturator nerve was measured from its origin to entrance of the foramen obturatum. The transverse diameter and thickness of the obturator nerve and femoral nerve on both sides were measured individually. The obturator nerve and femoral nerve of each specimen were cut into histological slice and the amounts of myelinated nerve fiber were ed respectively.
Result: The contralateral proximal obturator nerve could be transfered to the distal femoral nerve through anterior surface of vertebrae, with the overlap of fiber terminals about 1~2 cm. The length, transverse diameter and thickness of the obturator nerve were (10.9±0.5) cm, (1.78±0.22) mm and (2.49±0.22) mm individually. The transverse diameter and thickness of femoral nerve were (4.07±0.39) mm and (5.57±0.42) mm individually. The obturator nerve contained 5867±1136 myelinated nerve fibers and the femoral nerve contained 15387±1126 myelinated nerve fibers. The myelinated nerve fiber numbers of the obturator nerve were about 1/3 of the femoral nerve.
Conclusions: The contralateral obturator nerve can be used as donor nerve to repair the femoral nerve in lumbosacral plexus nerve avulsion injuries.
|李峰. 腰骶丛神经损伤的手术探查结果分析 & 健侧闭孔神经移位修复腰骶丛神经撕脱伤的解剖学观察[D]. 北京大学第四临床医学院. 北京大学,2016.|