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背景:电击伤后,确定神经损伤和移植神经吻合的部位,是神经功能恢复的关键所在。临床上常把在手术显微镜下看到神经正常轴索作为神经正常之起始。但术后效果常表明此方法不可靠。目的:评估体感诱发电位技术在电击伤后神经损伤检测中的运用价值。设计:病例回顾性分析。单位:上海交通大学医学院附属第九人民医院整形外科。对象:选择上海第九人民医院整形外科收治的12例腕部严重电击伤患者。其中男9例,女3例;年龄为6～54岁。方法:对受损神经连续测定体感诱发电位值,并相应作病理切片观察。以体感诱发电位选择平面行神经移植病例的功能恢复情况进行随访、比较。主要观察指标:受损神经体感诱发电位的波幅、潜伏期,相应的病理切片情况以及体感诱发电位选择平面行神经移植病例的功能恢复情况。结果:12例全部进入结果分析。①波幅、潜伏期与神经干质量呈正相关,病理检查支持这一结果。②12例通过体感诱发电位确定神经移植的吻合部位,8例术后得到随访,随访时间17～26个月,平均22.7个月。其中5例术后两点辨别觉达到Ⅱ或Ⅲ级(美国手外科协会标准,二点辨别距<6mm为Ⅰ级,6～10mm为Ⅱ级,11～15mm为Ⅲ级,>15mm为Ⅳ级)。结论:电击伤后神经损伤的病理改变复杂,体感诱发电位技术能有效地评估和选择神经移植的吻合部位。
Background: After electrical injury, determining the site of nerve injury and graft anastomosis is the key to the recovery of neurological function. Clinically often see the normal axons under the operating microscope as the normal start of the nerve. But postoperative effects often indicate that this method is not reliable. Objective: To evaluate the value of somatosensory evoked potential in the detection of nerve injury after electric shock. Design: Case retrospective analysis. Unit: Ninth People ’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine. PARTICIPANTS: Twelve patients with severe electric wrist injuries were selected from the Department of Plastic Surgery, Shanghai Ninth People’s Hospital. Including 9 males and 3 females; aged 6 to 54 years old. Methods: The value of somatosensory evoked potentials was determined continuously on the damaged nerves, and the pathological sections were observed accordingly. The somatosensory evoked potentials were selected for the functional recovery of planar nerve transfer cases and followed up for comparison. MAIN OUTCOME MEASURES: Amplitude, latency, corresponding pathological sections of the somatosensory evoked potentials of impaired nerves, and the functional recovery of the patients undergoing planar nerve transfer with somatosensory evoked potentials. Results: All 12 patients entered the result analysis. ① amplitude, latency and nerve dry mass was positively correlated, pathological examination support this result. ② In 12 cases, the site of anastomosis of nerve transplantation was determined by somatosensory evoked potentials. Eight patients were followed up for 17-26 months with an average of 22.7 months. Five of them were classified as Grade II or III at two points after surgery (American Society of Hand Surgery, Grade I with two-point discrimination <6 mm, Grade II with 6-10 mm, Grade III at 11-15 mm and Grade IV at> 15 mm ). Conclusion: The pathological changes of nerve injury after electrical injury are complicated. Somatosensory evoked potential technique can effectively evaluate and select the anastomotic site of nerve graft.