外科学课件：周围神经损伤（英文版）.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Peripheral Nerve Injury,Peripheral nerves,31 pairs of spinal nerve root,4 nerve plexus:,cervical,brachial,lumbar,sacral,myelin sheath,axons,neural tube or nerve trunk,Neurapraxia(Class 1)-,temporary paralysis of a nerve caused by lack of blood flow or by pressure on the affected nerve with,no loss of structural continuity,.,there is localized degeneration of the myelin sheath with transient nerve block.,Axonotmesis,(,Class 2,),-,neural tube intact,but axons are disrupted.These nerves are likely to recover.,Neurotmesis,(Class 3),-,the neural tube is severed.These injuries are likely permanent without repair,and will likely only achieve partial recovery at best.,Seddons classification(1943),expanded Seddons classification to five degrees of peripheral nerve injury,First-degree,(Class 1):Seddons neuropraxia,Second-degree,(Class 2):Seddons axonotmesis,Third-degree,(Class 3):,nerve fiber,interruption.,Epineurium and perineurium remain intact.,Recovery from a third-degree injury is possible,Surgical intervention may be required.,Fourth-degree,(Class 3):only the epineurium remain intact.,Surgical repair is required.,Fifth-degree,(Class 3):complete transection,Recovery is not possible,Need an appropriate surgical treatment.,Sunderlands classification(1951),Degree of Nerve injury,Neurapraxia,A relatively mild form of nerve injury(grade I neuropathy),Acute insult to nerve resulting in interruption of impulse transmission,May have motor and sensory involvement,Full recovery with conservative treatment with in 21 days,Neuropraxia,Axontomesis,Axonotmesis,An injury causing disruption of the axon and myelin sheath of a nerve,Nerve remains intact,Degeneration to axon distal to point of injury,but regeneration is usually spontaneous.,Prognosis depends on degree of lesion and lesion location,Axontomesis,Neurotomesis,Transection of nerve trunk,Most severe damage,Requires surgical intervention,Neurotomesis,Surgical procedures,Suturing of epineurium,Nerve Cuff and Nerve Graft,Funicular Repair,a bundle of nerve fibres enclosed within a sheath,Funiculus is,肌皮神经,的起源、走行和分支,Origin,、,course and branches of the,musculocutaneous nerve,桡神经的起源、走行、分支和易损部位,Origin,、,course,、,branches and vulnerable sites of the radial nerve,正中神经的起源、走行、分支和易损部位,Origin,、,course,、,braches and vulnerable sites of the median nerve,尺神经的起源、走行、分支和易损部位,Origin,、,course,、,branches and vulnerable sites of the ulnar nerve,坐骨神经的起源、走行、分支和易损部位,Origin,、,course,、,branches and vulnerable sites of the sciatic nerve,胫神经的起源、走行、分支和易损部位,Origin,、,course,、,branches and vulnerable sites of the tibial nerve,腓神经的起源、走行、分支和易损部位,Origin,、,course,、,branches and vulnerable sites of the peroneal nerve,Tinels sign,is a way to detect irritated,nerves,.It is performed by lightly tapping(percussing)over the nerve to elicit a sensation of tingling or,pins and needles,in the distribution of the nerve.,Mnemonic,A good way to remember what muscles are in the thenar eminence is OAF;oafs have big thenar eminences.O=opponens,A=abductor,F=flexor.There is only one opponens.The other two muscles each have a long partner and thus are called brevis.,Meat-LOAF:the M in the word Meat helps you remember that the LOAF muscles of the hand are innervated by the Median Nerve,ABOF(pronounced above)the Law muscles.The law states muscles of the hand are supplied by ulnar nerve.However,ABOF the Law muscles are supplied by MEDIAN nerve.AB=abductor,O=Opponens,F=Flexor,Law L=Lateral Lumbricals(2).,MAINTAINER-Main(Median nerve)-Tainer(thenar muscles),Thenar eminence,Stupid or awkward person,Hypothenar eminence,The three muscles are:,Abductor digiti minimi,Flexor digiti minimi,Opponens digiti minimi,Injuries of Median,Radial,and Ulnar Nerves,Common goals,Maintain a balance between muscle structures,Maximize functional use of extremity,Decrease pain and parasthesia,Protect surgical repair,Protect sensation deprived areas,Prevent,Over-stretching,Joint stiffness,Contractures,Median Nerve Injury,Median Nerve Injury,Symptoms present,(,what we look for,),Loss of thumb,opposition(The muscle action that,enables the pad of the thumb to make contact with the pad of the other fingers,),Opponens pollicis muscle,Weak abduction,APB,“Apehand”,(note thenar atrophy),(Coppard,2001),APB:abductor pollicis brevis,one with the thumb permanently extended,猿手,Symptoms present,(,what we look for,),Loss IP thumb flexion,FPL,Weak MP thumb flexion,Superficial FPB,Median Nerve Injury,Median Nerve Injury,Protocol,(,what should we do,),Maintain the first web space,Prevent contracture,C-Bar Splint,(Coppard,2001),Median Nerve injury,Protocol,(,what should we do,),ROM,Flexion-assist splint,(Tenney,1986),Additional symptoms,(,what we look for,),Weak wrist flexion,Weak finger flexion,FDS&FDP(radial side),Protocol,(,what we do,),Treat the symptom,Maximize function,Protect if repaired surgically,Radial Nerve Injury,Symptoms present,(,what we look for,),Loss of wrist extension,ECU,ECRL&ECRB,Loss of fingers and thumb ext。