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学科主题: 外科学
题名:
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
作者: 李峰
答辩日期: 2016-05-19
导师: 王树锋
专业: 外科学
授予单位: 北京大学
授予地点: 北京大学第四临床医学院
学位: 博士
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
分类号: R687.3
摘要:

Part1: 腰骶丛神经损伤的手术探查结果分析

目的:探讨不同类型腰骶丛神经根损伤的部位及性质。

方法:2004年11月至2015年9月,共为92例(其中双侧损伤12例)腰骶丛神经根损伤患者进行腹膜后腰神经丛及(或)盆腔内骶神经丛及(或)腰骶管神经根手术探查。男68例,女24例;年龄4-62岁,平均29岁。伤后时间为1-48个月,平均7.8个月。高处坠落伤23例,车祸伤36例,重物砸伤13例,挤压伤14例,刀扎伤3例,医源性损伤3例。根据每例患者术前临床表现、查体及术中探查神经根受累情况,将腰骶丛神经根损伤分为六型,总结出不同临床分型的腰骶丛神经根常见损伤部位及损伤性质。

结果:腰骶丛神经根完全损伤型(L1-S3)5例,损伤部位全部(100%)位于椎管内,2例发生神经根的断裂,2例撕脱,1例断裂和撕脱均发生;腰丛+上骶丛损伤型(L1-S1)7例,6例(85.7%)损伤部位位于椎管内(2例撕脱,4例断裂),1例为盆腔内牵拉伤;骶丛神经损伤型(L4-S3)32例,21例(65.6%)损伤部位位于椎管内(12例撕脱,1例牵拉,8例断裂),11例为盆腔内或骶前孔处挫伤;上骶丛神经损伤型(L4-S1)25例,6例损伤部位位于椎管内(1例断裂,1例牵拉,4例撕脱),19例(76%)为盆腔内或骶前孔处挫伤;下骶丛神经损伤型(S2-S3)11例,4例损伤部位位于椎管内(均为断裂),7例(63.6%)为盆腔内及骶前孔处挫伤,其中7例为双侧损伤;腰丛神经损伤型(L1-L3)12例,3例损伤部位位于椎管内(均为断裂),9例(75%)为腹膜后断裂或牵拉伤。

结论:全腰骶丛神经根损伤型、腰丛+上骶丛损伤型和骶丛神经根损伤型主要损伤部位为椎管内,此处损伤几率分别为100%、85.7%和65.6%,均为神经根断裂或撕脱伤。上骶丛神经根损伤型和下骶丛神经根损伤型主要损伤部位在盆腔内或是椎孔处,损伤率分别为76%和63.6%,腰丛神经根损伤型主要损伤部位在腹膜后,损伤几率为75%,均为神经根牵拉伤或断裂。

Part2: 健侧闭孔神经移位修复腰骶丛神经撕脱伤的解剖学观察

目的:观察健侧闭孔神经移位修复腰骶丛神经根撕脱伤的可行性。

方法:取10具成人尸体标本,显露双侧闭孔神经及腰骶丛神经根。测量闭孔神经从主干起始部至闭孔入口处的长度及其在闭孔入口处的横径和纵径,计算横截面积,并在高倍显微镜下计数有髓神经纤维数目。测量股神经主干起始处的横径和纵径,计算横截面积,并在高倍显微镜下计数有髓神经纤维数目。分别测量健侧闭孔神经经椎体前通路(髂血管前和髂血管后)到达对侧股神经主干起始处的距离。

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。

结论:闭孔神经可作为动力源神经移位修复腰骶丛根性撕脱伤。

英文摘要:

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.

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/124756
Appears in Collections:北京大学第四临床医学院_学位论文

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作者单位: 北京大学第四临床医学院

Recommended Citation:
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.
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