3.1. Khau vo bao than kinh
Khi khau than kinh bi dtit, nen dung kinh lup hay ki'nh hien vi phau thuat. Thong thUdng, dung lup la du. TrUdc het phai cat loc cac d&u mut than kinh cho het to chtic dap nat (xem hinh 4.1).
Khi khau vo bao than kinh, co 2 dieu quan trong: - Khau than kinh khong cang
- Khau than kinh khong xoay
C&n quan sat than kinh dua vao cac mach mau chay doc vo bao. Danh dau ca 2 dau, xong khau cho dung, khong bi xoay, khau vdi chi khong tieu. Than kinh ldn dung chi nylon 8-0, than kinh nho vi du d ngon tay, dung chi 10-0. Khi khau bao than kinh, khong dtfdc xiet chi chat vi cac bo than kinh se bi lech hang. Nen de lai 1 khe hd nho d dau mut than kinh vdi cac bo thang hang. Sau khi khau mui dau tien d vo bao thi mui thti 2 khau d phia doi dien. Khi khau rap cac dau than kinh thi so' mui khau cang it cang tot. Neu vdi chi nylon 8-0 khong the rap cac dau than kinh vdi nhau thi day la cang qua, c ln boc lo than kinh hay lam 1 thu thuat khac. Sau khi khau khong dtfdc co bo than kinh nao loi qua cho khau.
3.2. Khau bo than kinh
Khau bo than kinh chi danh cho than kinh nao co it bo, vi du than kinh ngon tay, than kinh tru d khuyu. Can khau bo vi theo Sunderland, than kinh tru d khuyu chi co 3-4 bo to (xem hinh 4.1).
Con than kinh gitia d 1/3 tren cang tay thi khong nen khau bo vi kho ma khau cho dung. Tai day, than kinh co nhieu bo qua, d§ khau nham.
Dau moi bo dtfdc dinh vdi nhau bang 2 mui chi vdi kinh lup, hay khau vat chi 10-0 vdi kinh hien vi phau thuat. Khi khau bo khong dtfdc cang neu vdi chi 10-0 ma khong giti dtfdc cac bo thi can doi phtfdng phap mo khac.
3.3. Khau nhom bo than kinh
Than kinh gitia d cang tay co 5 nhom bo - than kinh tru d co tay co chting 4 nhom bo. Khau theo nhom bo thi tot hdn la khau bo than kinh.
4. KHAU THAN KINH KY 2
Dau tren cua than kinh dtit can cat den to chtic lanh, nhtf vay, de lai 1 cho khuyet than kinh can bac cau. Do can lap cho khuyet nen thUdng khau cang, do do it khi co the lam dtfdc khau bo than kinh hay nhom bo than kinh, thtfdng luc nay chi khau bao than kinh. Khau bao than kinh do Seddow pho bien va rat hay lam sau chien tranh. Dau than kinh can dam bao cat het Seddon de than kinh co the moc cac tru true.
Khi cat loc 2 dau than kinh thi cho khuyet thtfdng la l,5-5cm . Noi chung, khuyet 4cm thi khac phuc bang cach di chuyen cac dau than kinh tai cho. Neu boc tach nhieu qua, th^n kinh se bi mat cac nhanh m ach m au ben. Boc loc dau tren
k „ h ^ h% ^ bQe 'o dau duo, Tuy co cac thong bao nhu than kinh gtfla. t h in ' “ f ° u . ta<i, ? uyen ch ° ra trudc >'6 the' lap d^y c h o kh u vet 7 9 c m tham ch. 13cm, than kinh qua y co the lap d i y ch6 khuyet 8cm. nhd gap th em cac
Jk XhA C'-n' T - Ca<: r ! a lam. n^Sn M «ng. song not chung vd, chuve'n chS,
gap khdp cung ch, co the lap day cho khuyet than k.nh la 4cm. Mat rong nSa thi
ghep bo than kinh con hdn. '
Hinh 4.1. Khau :^6 va khau bao than W nhic*’ *
5. GHEP THAN KINH
Chi dinh ghep than kinh khi bi khuyet than kinh tren 4cm.
Co 3 kieu ghep th&n kinh: dung than kinh khac loai, dong loai va tU than. D ung than kinh khac loai it co ket qua, chu yeu do thai loai mien dich. Dung than kinh dong loai bao quan co mot it ket qua song bi nhieu to chtic xd nen han che ket qua. Tot nhat la dung than kinh ttf than.
Ghep than kinh bat dau tut Lister (1866) song Seddon (1947) mdi co so ltfdng ldn, tren 100 benh nhan. Ket qua tot thUdng thay d tre em vdi ghep than kinh nho nhu thSn kinh ngon tay. Seddon ket luan: d ngon tay, ghep than kinh tot hdn la khau thi 2.
Noi chung, sau c&t bo u than kinh d dau than kinh dtit, neu mat qua 4cm thi nen ghep.
6 tre em, ket qua tot nhieu so vdi ngtfdi ldn va d ngtfdi gia tren 50 tuoi thi hoi phuc it, du ky thuat ghep la hoan hao.
Nguon cho than kinh chinh la than kinh bap chan (Sural nerve). Than kinh nay nam doc sau bap chan, d chinh gitia va nam sat phia ngoai tlnh mach hien ngoai. Benh nhan nam nghieng, neu lay 2 ben thi nam sap. Co the lay d mot so ndi khac, vi du lay d than kinh cang tay bi trong va ngoai, nam d to chtic dudi da, sat tinh mach nen (d trong) va tlnh mach dau (d ngoai) tai cang tay.
Chon phtfOng phap ghep: Bi thtfdng tdn than kinh cao, can ghep bo hay nhom bo. Bi thtfdng tdn thap, chi ghep bo than kinh.
Ve thdi gian nen ghep sau thtfdng tdn dtfdi 6 thang. Song co khi v ln co cam giac du ghep muon sau thtfdng tdn ca nam.
6. CHAN DOAN T H lfO N G TON THAN KINH SAU GAY XUONG6.1. Gay cot song 6.1. Gay cot song
Vdi gay cot song co liet tuy, ta thay cac dac diem sau:
- 24 gid dau la giai doan choang tuy, kham thay mat het van dong va cam giac, phan xa song chtfa biet ro mtfc do thtfdng tdn tuy. Het giai doan choang tuy, bo mat that cua thtfdng ton tuy song mdi hien ra.
- Chan doan doan tuy bi thtfdng tdn chu yeu dtfa vao cam giac: + M at cam giac den ngang vu, thtfdng tdn doan tuy T2
+ M at cam giac den mui tic, thtfdng tdn doan tuy T6 + M at cam giac den ron, thtfdng tdn doan tuy T10
+ M a t cam giac den nep ben, thtfdng tdn doan tuy T 12 + Ma't cam giac den 1/3 dtfdi dui, thtfdng tdn doan tuy L l
- Chan doan mtic do liet van dong, theo bang Frankel + O diem: liet hoan toan
+ 1 diem dau ngon chan nhuc nhich, 1 bo cd noi han theo yeu c l u
+ 2 diem cU dong dUdc song k h on g ch on g dtfdc trong luc (stic hut qua dat) + 3 diem cti dong, ch on g dtfdc trong luc
+ 4 diem ch on g dtfdc stic can kha + 5 diem binh thUdng