12-周圍神經(jīng)損傷（黃仕龍）ppt

1、,Peripheral Nerve Injury,同濟醫(yī)院骨外科 黃仕龍,Contents,General topic introduce definition classification pathological change outcomes diagnosis treatments,Specific injury radial nerve median ne

2、rve ulnar nerve femoral nerve tibial nerve peroneal nerve,What is peripheral nerve?,It is a structures which connects central nerve system and terminal orgnas, and transmits electronic potential.Moter n

3、erveSensory nerveMixed nerve,Functions & Characteristics,Transmit electronic information Features 1. conductivity 2. reproducibility 3. ....,How many? Who are they?,31 pairsC1-4 cervical plexusC4-Th

4、1 brachial plexus Th1-Th12 thoracic nerveTh2-L4 lumbar plexusL4-S5 sacral plexus：,Classification,NeuropraxiaAxonotmesisneurotmesis,NeuropraxiaMost minor damage, such as slight tension…Appearance is intact, may

5、have cell or molecular change;Lose conductivity temporary; A movement disorder, but without atrophy; B sensory disorder, but still exist; C with biological potential,Histopathological change,Axon

6、otmesis medium damage, such as contusion..Appearence: looks good, bead-shape, or hollow feeling;Histological: epineurium intact, but fiber rupture, or tract damage with inner haemorrhagia and scar;Lose moter, sen

7、sory, and electronic reaction.,histopathological change,NeurotmesisSevere damage, such as shape damage, avulsion.. Continuity was totally broken; Without any moter, sensory, vegetative nervous reaction, muscle begin

8、atrophy;Without any potential.,Histopathological change,During w1-w4：Wallerians’ Degeneration: axon & myelin sheath shrinking, smash, broken. Then Macrophage coming...Schwann’s effect: rest Schwann’s ce

9、ll proliferation, form hollow pipe, then new axons coming.,Pathological outcome,Repair timely and properly 2-3w, axon regenerate 4w, get through new Schwann’s membrane pipe NGF, E. stimulation induce the axon

10、heading to terminal organs1mm per day,Results,Repair too late or improperlypressure, scar or poor blood supply impede axon growth>6w, Schwann’s membrane smash to piecesEndplate degeneration and disappear, muscle

11、 atrophy;nonreversible,Results,Diagnosis,History: Symptom： ①movement dysfunction; ②sensory disfuction ; ③vegetative nervous dysfuction; Tinel signElectrophysiologic study (EPS),active movementmyodynamia,Mo

12、vement dysfunction,Lose algesia, thermal sense, pselaphesiaHow to test: use a pin: healthyside first, then the wounded side use some soft subjects, such as cotton swab; use cold water(5-10℃), or warm water(

13、40-45 ℃); feel different shape when blindly;twopoint discrimination test; normally 2-4mm,Sensory disfuction,Skin: smooth, adiapneustia;Iodostarch reaction:Nail: cracking,Vegetative nervous dysfuction,Use finger or

14、 small hammerOver inductance means N. regeneration. Positive site,Tinel’s test,Normal action potential: 40～70m/sec fibrillation potential(2～4w): om/sec,Electrophysiologic study(EPS),Tr

15、eatments,strategies of treatment Diagnose properly Operate early,Neuropraxia or closed Axonotmesis Conservative Treatment for 3m;Physiotherapy;acusector;Nerve growth factor,Treatments,Neuropraxia or closed Axo

16、notmesis >3m without recover or improveNerve relieve or neurolysis,Treatments,Treatments,Opening Neroirgure Gompletly1. primary repair: immediately;2.Extension repair: during w1-w3;3.Secondary repair: during m

17、1-m2;4.Delayed repair: poor outcome,Operational construction1. neurorrhaphy ①end-to-end anastomosis ②end-to-side anastomosis2. Nerve Brisement3. nerve grafting4. nerve implantation,Treatments,Deal with

18、Neurolesion1. Dissociate proximal and distal(<5cm);2. Flax the joint;3. Neural inversion;4. Remove some bone;5. Transplantation;6. gap bridging;7. replacement.,Treatments,Specific topic,Median nerve injury,Cons

19、titution:Innervated: nearly all flexor of forearm;Injure at wrist: Ape hand deformity,..At elbow: flexor of thumb, index, middle finger;At upper arm:,Constitution:Innervated: flexor of ring finger and little fi

20、ngerInjure at wrist: clawhand deformity, intrinsic muscle atrophy..At elbow: flexor of ring finger, little finger;,Ulnar nerve injury,Radial nerve injury,Constitution: superficial & deep branch Innervated: all

21、 extensor Injure at wrist: Tucks area, At elbow: extensor of fingerAt upper arm: extensor of wrist,Femoral nerve injury,Constitution: L2，3，4Innervated: quadriceps femoris, sartoriusInjure: knee extension dysfun

22、ction,,Tibial nerve injury,Constitution: come from sciatic nerve; anterior & posterior branch Innervated: all flexor of ankle, sense of the soleInjure at thigh: most common caused by supracondylar fracture of fem

23、ur;,Peroneal nerve injury,Constitution: come from sciatic nerve; Innervated: the lateral crus muscle group, sensory of the lateral crus & dorsum of footInjure at thigh: Pedal deformity, drop toe; sensory disturba