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上肢及手部神经损伤。

Nerve injuries of the upper extremity and hand.

作者信息

Dahlin Lars B, Wiberg Mikael

机构信息

Department of Translational Medicine - Hand Surgery, Lund University, and Skåne University Hospital, Malmö, Sweden.

Department of Surgical and Perioperative Science, University Hospital, and Department of Integrative Medical Biology, Umeå University, Sweden.

出版信息

EFORT Open Rev. 2017 May 11;2(5):158-170. doi: 10.1302/2058-5241.2.160071. eCollection 2017 May.

Abstract

A nerve injury has a profound impact on the patient's daily life due to the impaired sensory and motor function, impaired dexterity, sensitivity to cold as well as eventual pain problems.To perform an appropriate treatment of nerve injuries, a correct diagnosis must be made, where the injury is properly classified, leading to an optimal surgical approach and technique, where timing of surgery is also important for the outcome.Knowledge about the nerve regeneration process, where delicate processes occur in neurons, non-neuronal cells (i.e. Schwann cells) and other cells in the peripheral as well as the central nervous systems, is crucial for the treating surgeon.The surgical decision to perform nerve repair and/or reconstruction depends on the type of injury, the condition of the wound as well as the vascularity of the wound.To reconnect injured nerve ends, various techniques can be used, which include both epineurial and fascicular nerve repair, and if a nerve defect is caused by the injury, a nerve reconstruction procedure has to be performed, including bridging the defect using nerve-grafts or nerve transfer techniques.The patients must be evaluated properly and regularly after the surgical procedure and appropriate rehabilitation programmes are useful to improve the final outcome. Cite this article: 2017;2. DOI: 10.1302/2058-5241.2.160071. Originally published online at www.efortopenreviews.org.

摘要

神经损伤会对患者的日常生活产生深远影响,这是由于感觉和运动功能受损、灵活性下降、对寒冷敏感以及最终出现疼痛问题。为了对神经损伤进行恰当治疗,必须做出正确诊断,对损伤进行准确分类,从而采用最佳的手术方法和技术,而手术时机对治疗结果也很重要。了解神经再生过程至关重要,因为在周围神经系统和中枢神经系统的神经元、非神经元细胞(即雪旺细胞)以及其他细胞中会发生微妙的过程,这对于主刀医生来说很关键。进行神经修复和/或重建的手术决策取决于损伤类型、伤口状况以及伤口的血运情况。为了重新连接受损的神经断端,可以使用多种技术,包括神经外膜修复和束膜神经修复,如果损伤导致神经缺损,则必须进行神经重建手术,包括使用神经移植物或神经转移技术来桥接缺损。手术后必须对患者进行适当且定期的评估,适当的康复计划有助于改善最终治疗效果。引用本文:2017;2. DOI: 10.1302/2058 - 5241.2.160071。最初在线发表于www.efortopenreviews.org。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e916/5467675/84ee6c3a1266/eor-2-158-g001.jpg

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