微创医学

目的研究人体骨骼肌失神经支配后,肌萎缩、肌纤维化程度与失神经支配时间的关系,探索一种安全、无创、准确性高的检测手段,为临床开展晚期神经修复时限的选择提供理论依据。方法对48例不同时限臂丛神经损伤患者的肱二头肌标本按神经损伤时限分为五组:0～3个月(10例)、3～6个月(14例)、6～12个月(8例)、1～2年(8例)、大于2年组(8例),对照组为患者对侧正常肱二头肌(48例)。对患者肱二头肌进行B超检测,并与对侧的正常肱二头肌作对比,以病理结果为金标准,评价B超检测肌萎缩程度的准确性。结果随着肱二头肌失神经时限的延长,肌纤维逐渐萎缩,肌肉截面积减小,纤维及脂肪组织逐渐增多,随着时间的推移,B超表现为肱二头肌内高回声影及与对侧正常肱二头肌截面积比逐渐下降,与病例检查结果相符。结论 B超能较好地反映失神经支配骨骼肌萎缩情况,对指导晚期神经修复具有积极意义。

Objective To research the relationship between amyotrophy,myofibrosis and time of denervation,explore a safe,non-traumatic and precise examination which can be theoretically helpful in selection of neural restoration deadline in clinic.Methods 48 biceps brachii of 48 patients′ injured arms were included and divided into 5 groups(10 patients of 0-3 months,14 patients of 3-6 months,8 patients of 6-12 months,8 patients of 1-2 years,8 patients of 2 years or more).The control group was 48 biceps brachii of patients′ uninjured arms.We took advantage of B-ultrasound in examing the injured arms,comparing to the uninjured arms,and evaluated the accuracy of B-ultrasound in examing amyotrophy,the pathological appearances as key criterion.Results As time of neural denervation prolonged,amyotrophy and myofibrosis became more and more serious,sectional areas of muscles became less and less,though fatty tissue was observed proliferating.B-ultrasound showed the ratio of sectional area of high-level echo in the injured arms decreased comparing to that of uninjured arms as the time prolonged,which coincided with pathological outcome.Conclusion B-ultrasound can observe state of amyotrophy after denervation well,which is crucial in neural restoration at the later period