Makarov M R, Birch J G, Delgado M R, Welch R D, Samchukov M L
Department of Neurology & Neurophysiology, Texas Scottish Rite Hospital for Children, Dallas, USA.
Clin Orthop Relat Res. 1996 Aug(329):310-6. doi: 10.1097/00003086-199608000-00038.
To identify factors affecting peripheral nerve function during limb lengthening, serial somatosensory evoked potentials studies were performed in 18 goats and correlated with gross appearance of the soft tissues at necropsy. In 15 goats, a 20% or 30% tibial lengthening was done using the Ilizarov apparatus at a rate of 0.75 mm per day and rhythm of 1, 4, or 720 times per day. Three animals served as frame/corticotomy controls. Seven lengthened and 2 control animals maintained normal somatosensory evoked potentials throughout the study. At necropsy, the peroneal and tibial nerves appeared grossly normal. In one control animal with irreversible loss of evoked potentials documented intraoperatively, peroneal nerve impalement by a transfixion wire was identified at necropsy. Eight lengthened animals experienced significant changes of peroneal nerve conduction. In 6 of these 8 animals, transfixion wires were found to be disrupting the nerve in some way. In the remaining 2 animals, no offending wires were identified, but there was extensive diffuse soft tissue fibrosis within the extremity. The rhythm of distraction did not have an important influence on evoked potential changes during the course of distraction. Although there was a correlation between the amount of lengthening performed and the degree of evoked potentials deterioration, the anatomic relationship between the wires and nerves was a more important factor in the development of these abnormalities.
为了确定肢体延长过程中影响周围神经功能的因素，对18只山羊进行了系列体感诱发电位研究，并将其与尸检时软组织的大体外观相关联。在15只山羊中，使用伊利扎罗夫器械以每天0.75毫米的速度、每天1次、4次或720次的节奏进行20%或30%的胫骨延长。3只动物作为框架/骨皮质切开术对照。7只延长肢体的动物和2只对照动物在整个研究过程中体感诱发电位均保持正常。尸检时，腓总神经和胫神经大体上正常。在1只术中记录到诱发电位不可逆丧失的对照动物中，尸检时发现一根固定钢丝刺穿了腓总神经。8只延长肢体的动物腓总神经传导出现显著变化。在这8只动物中的6只，发现固定钢丝以某种方式干扰了神经。在其余2只动物中，未发现有问题的钢丝，但肢体内部有广泛的弥漫性软组织纤维化。牵引节奏在牵引过程中对诱发电位变化没有重要影响。虽然延长的长度与诱发电位恶化程度之间存在相关性，但钢丝与神经的解剖关系是这些异常发生的更重要因素。
