正中神经、尺神经部分束支移位术重建屈肘功能  

Fascicle of median nerve or ulnar nerve transfer to reconstruct the function of elbow flexion

作　　者：李玉成[1] 常万绅[1] 诸寅[1] 张长清[1] 张云涛[1] 王海华[1] 李忠哲[1] 

机构地区：[1]北京积水潭医院手外科,100035

出　　处：《实用手外科杂志》2000年第4期201-205,共5页Journal of Practical Hand Surgery

摘　　要：目的 观察正中神经、尺神经部分束支移位术的临床疗效及手术前后供体神经功能的变化,分析影响手术疗效的因素.方法 应用正中神经、尺神经部分束支移接给肱二头肌肌支治疗臂丛神经上干型根性撕脱伤,重建屈肘功能.对施行手术的36例患者进行6个月至5年多的随访,根据肱二头肌肌力和肘关节主动活动范围,将患者术后恢复情况分为三级:优:肱二头肌肌力达4级以上,肘关节屈曲达90度以上;可:肱二头肌肌力达3级,肘关节屈曲达60～90度;差:肱二头肌肌力2级以下,肘关节屈曲60度以下.分析影响疗效的几种因素.结果 手术疗效显著,有效率(肱二头肌肌力3级以上)达94.4%,优良率(肱二头肌肌力4级以上)达63.9%.手术前后供体神经功能没有明显变化.影响手术疗效的主要因素有:损伤类型、损伤原因、手术距损伤的间隔时间、患者年龄、供体神经的选择及术后功能锻炼.准确判断患者的损伤类型,严格掌握手术适应证是手术成功的关键.结论 正中神经、尺神经部分来支移位术是治疗臂丛神经上干型根性撕脱伤的一种安全、可靠、有效的手术方法.ve To observe the clinical effect of fascicle of median nerve or ulnar nerve transfera-tion. Methods Thirty - six patients with absent elbow flexion secondary to brachial plexus injury underwent nerve transfer using a part of median and ulnar nerve to the motor branch of the biceps muscle. Follow-up period ranged from 6 months to 65 months (average 29. 2 months) . Results Twenty-three patients had biceps strength M4 and flexed elbow joint more than 90 degree. Eleven patients had biceps strength M3 and flexed elbow joint 60 - 90 degree. Only two patients had poor result. The type and cause of injury, interval, donor nerve, age and rehabilitation would have effect the result. Conclusion Fascicle of median nerve or ulnar nerve transferation is a safe and effective way to treat some brachial plexus injury.

关 键 词：肱二头肌 肌力 尺神经 正中神经 移位术 患者 肘关节 经部 准确 情况 

分 类 号：R658.2[医药卫生—外科学]