Khanna Achal, Mahajani Ravi, Proudman Timothy
Department of Surgery, Queen Elizabeth Hospital, University of Adelaide, Australia.
Med Princ Pract. 2006;15(1):87-9. doi: 10.1159/000089394.
To describe a successful case of sural nerve cable grafting to the leg following a gunshot injury.
A 28-year-old man was shot at close range, sustaining extensive damage to the left popliteal fossa. Initial exploratory operation revealed a pierced sciatic nerve proximal to its bifurcation into the tibial and common peroneal branches. The 60% division 3.5-cm common peroneal deficit and the complete transection of the tibial division were repaired using an ipsilateral sural cable nerve graft that was not reversed. Initial re-assessment in the clinic setting revealed a denervation atrophy of all 3 leg compartments and paraesthesia below the left knee sparing the sural nerve. After 3 months, the patient had a significant improvement in both power and sensation which was felt to be due to a resolution of a neuropraxic component to the nerve injury. Re-assessment at 9 months and later at 14 months revealed an almost full recovery, suggestive of the success of the nerve grafting procedure.
This report shows that, given favourable conditions, a good result is possible following use of cable nerve grafting to treat nerve damage from gunshot.
描述一例枪伤后将腓肠神经电缆移植至腿部的成功病例。
一名28岁男性遭近距离枪击，左腘窝受到广泛损伤。初次探查手术发现坐骨神经在分叉为胫神经和腓总神经分支的近端被穿透。使用未翻转的同侧腓肠神经电缆移植物修复了3.5厘米长、60%离断的腓总神经缺损以及胫神经分支的完全横断。在临床环境中的初次重新评估显示，小腿所有三个肌间室均出现失神经萎缩，左膝以下感觉异常，但腓肠神经未受影响。3个月后，患者的肌力和感觉均有显著改善，这被认为是由于神经损伤的神经失用成分得到缓解。9个月及之后14个月的重新评估显示几乎完全恢复，表明神经移植手术取得成功。
本报告表明，在有利条件下，使用电缆神经移植治疗枪伤所致神经损伤可能会取得良好效果。
