Williams H B
Department of Plastic and Reconstructive Surgery, McGill University, Montreal Children's Hospital, Quebec, Canada.
Microsurgery. 1996;17(11):597-605. doi: 10.1002/(SICI)1098-2752(1996)17:11<597::AID-MICR6>3.0.CO;2-M.
This clinical pilot study evolved from a 10-year experience in the experimental laboratory using continuous muscle stimulation in a series of animal studies following nerve injury and microsurgical repair. A completely implantable system was developed (Medtronic) to provide electrical stimulation to the denervated muscles until nerve regeneration had occurred. Both peripheral nerve injuries in the extremities and facial nerve severances were studied, and a definite improvement in functional capacity was obtained as well as improved morphology compared with nonstimulated controls. In this study, 13 patients with peripheral nerve injuries in the upper extremity are included. All patients had muscle stimulation for extended periods until nerve regeneration was evident; a careful analysis of their functional capacity was then completed. There were five patients with median nerve injuries, four with ulnar nerve or combined median-ulnar nerve injuries, and four with severed radial nerves. All patients showed satisfactory nerve regeneration on clinical examination and electromyographic studies. Motor recovery was usually better than sensory return. Functional muscle analysis varied somewhat from patient to patient, but every patient had a satisfactory to excellent recovery. Patients with low nerve lesions had better results, but muscle recovery even in patients with mid-forearm or higher nerve injuries was most encouraging. Functional recovery in radial nerve injuries was close to normal in all cases. The results from this pilot study have clearly shown the benefits of continuous muscle stimulation using an implantable system following nerve injury and repair.
这项临床试点研究源于在实验实验室进行的为期10年的经验，即在一系列神经损伤和显微外科修复后的动物研究中使用持续肌肉刺激。开发了一种完全可植入系统（美敦力公司），用于向失神经支配的肌肉提供电刺激，直至神经再生发生。研究了四肢的周围神经损伤和面神经切断，与未刺激的对照组相比，功能能力得到了明显改善，形态也有所改善。在本研究中，纳入了13例上肢周围神经损伤患者。所有患者都接受了长时间的肌肉刺激，直到神经再生明显；然后对他们的功能能力进行了仔细分析。有5例正中神经损伤患者，4例尺神经或正中-尺神经联合损伤患者，4例桡神经切断患者。所有患者在临床检查和肌电图研究中均显示出令人满意的神经再生。运动恢复通常优于感觉恢复。功能性肌肉分析在不同患者之间略有差异，但每个患者都有令人满意到极好的恢复。低位神经损伤患者的结果更好，但即使是前臂中部或更高神经损伤的患者，肌肉恢复也非常令人鼓舞。桡神经损伤的功能恢复在所有病例中都接近正常。这项试点研究的结果清楚地表明了在神经损伤和修复后使用可植入系统进行持续肌肉刺激的益处。
