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目的为早期神经瘤切除、臂丛修复治疗产瘫提供理论依据。方法对44例早期产瘫手术患儿,术中作臂丛上干神经电生理测定( 3 7例) ,随后切除神经瘤、行神经移植和移位修复臂丛术。对神经瘤进行如下检测大体观察、LuxolFastBlue髓鞘染色、Van Gieson胶原纤维染色、透射电镜观察、神经丝蛋白的单克隆抗体标记以计数轴索等。另取2 3侧新鲜婴儿尸体的臂丛上干进行对照研究。结果术中发现臂丛上干神经瘤呈梭形或“双峰骆驼”形,瘤长1.2～1.5cm ,质硬。神经瘤近端可见大量的有髓神经纤维;远端的神经外膜、束膜内胶原纤维明显增生,束内再生的有髓神经纤维分布不均。神经瘤和正常上干内胶原纤维相对面积分别为( 63 73 %±12 2 7, x±s ,下同)和42 .3 8%±11.18% ,差异有统计学意义(P<0 .0 1)。透射电镜观察显示,不同髓鞘厚度的神经纤维和脱髓鞘病变分布于神经瘤远、近端和中央段。神经瘤近端和正常上干神经纤维数的差异有统计学意义(P <0 .0 1) ;神经瘤内再生神经纤维的通过率41.67%±8.0 0 %。根据被检肌肉(冈下肌、三角肌、肱二头肌)能否引出复合动作电位(CMAP)将患儿分为三组,被检肌肉波幅均有明显下降。但方差分析表明,三组再生神经纤维通过神经瘤的比率差异无统计学意义(P >0 .0 5 )。结论有早期手术指征的臂
Objective To provide a theoretical basis for early neuroma resection and brachial plexus repair for the treatment of paraplegia. Methods Forty-four children with early paralysis were enrolled in this study. The brachial plexus nerve was electrophysiologically analyzed (37 cases), followed by excision of neuroma, nerve graft and brachial plexus replacement. Neuroblastoma were examined as follows: LuxolFastBlue myelin staining, Van Gieson collagen staining, transmission electron microscopy, monoclonal antibody labeling of neurofilament to count axonal and so on. Another 23 fresh cadaveric brachial plexus on the dry control study. Results Intraoperative findings on the brachial plexus of the dry neuroma showed fusiform or “bimodal camel” shape, tumor length 1.2 ~ 1.5cm, hard. A large number of myelinated nerve fibers can be seen in the proximal part of the neuroma. The distal epineurium and the collagen fibers in the fascicles proliferate remarkably, and the regenerated myelinated nerve fibers in the bundle are unevenly distributed. The relative areas of neurofibroma and normal upper dermis were (63 73% ± 12 2 7, x ± s, the same below) and 42.38% ± 11.18%, respectively, the difference was statistically significant (P <0. 0 1). Transmission electron microscopy showed that nerve fibers with different myelin sheath thickness and demyelinating lesions were located in the far, proximal and central segments of the neuroma. There were significant differences in the number of nerve fibers between the proximal and the normal neuroma (P <0.01). The passage rate of nerve fibers in the neuroma was 41.67% ± 8.0%. According to the seized muscles (subconjunctival, deltoid, biceps) can lead to compound action potential (CMAP) will be divided into three groups of children, the seized muscle amplitude were significantly decreased. However, analysis of variance showed that there was no significant difference in the rate of regenerating nerve fibers between the three groups (P> 0.05). Conclusion There are arms for early surgical indications