正中神经部分束支移位与肌皮神经肱二头肌肌支缝合重建屈肘功能  

Median nerve fascicle transfer to biceps muscle branch of the musculocutaneous nerve for restoration of elbow flexion

作　　者：常万绅[1] 李玉成[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：《中华手外科杂志》2005年第2期89-92,共4页Chinese Journal of Hand Surgery

摘　　要：目的评价正中神经部分束支移位与肌皮神经肱二头肌肌支缝合重建屈肘功能的疗效,观察供体神经功能的变化并讨论影响疗效的因素和手术适应证。方法对1995年以来的45例臂丛神经上干根性损伤者,采用正中神经部分束支移位与肌皮神经肱二头肌肌支缝合术。术中切取正中神经后内侧,横截面的1/6～1/5为移位束支,因为来自内侧束的神经纤维多位于后内侧。术后随访12～10 8个月,患者最终恢复结果按中华医学会手外科学会上肢部分功能评定试用标准评定。结果手术有效率达到86.7% ,优良率达60 .0 %。1/4患者在术后出现供体支配肌肌力和握力减退,术后1～2个月恢复正常。该组中以C5,6根性损伤伴中下干部分损伤、骑摩托车摔伤、41岁以上年龄组的疗效最差。结论正中神经部分束支移位于肌皮神经肱二头肌肌支是治疗臂丛神经上干型根性撕脱伤、重建屈肘功能的一种简单、安全、可靠而有效的手术方法。损伤类型、损伤原因、手术距损伤的间隔时间、患者的年龄及术后的功能锻炼,是影响手术疗效的主要因素。准确判断损伤类型,严格掌握手术适应证是手术成功的关键。Objective The treatment outcome of partial median nerve transfer for elbow flexion restoration in brachial plexus injuries was evaluated. The impact on the donor nerve function, factors influencing the results, and the surgical indications were also discussed. Methods 45 patients who sustained injury of the upper trunk of brachial plexus underwent nerve transfer using a part of the median nerve to the biceps muscular branch of the musculocutaneous nerve. The posteromedial portion accounting for 1/6-1/5 of the median nerve was harvested as neurotizer. Follow-up period ranged from 12 to 108 months. The standard issued by the Hand Surgery Society of Chinese Medical Association was adopted to assess the upper limb function postoperatively. Results 27 patients had biceps strength of M4 and elbow flexion of more than 90°. 12 patients had biceps strength of M3 and elbow flexion of 60～90°. The overall effective rate was 86.7%. Weakness of median nerve innervated muscles and reduced grip strength were found in 1/4 of the patients immediately after the operation but recovered within 1 to 2 months. Poor treatment results were seen in patients having accompanying partial injury of the middle or lower trunk, being older than 41 years, and whose cause of injury was motorcycle accident. Conclusion Partial median nerve transfer for elbow flexion restoration is a simple, safe and effective procedure for brachial plexus upper trunk avulsions. The type and cause of injury, the interval between injury and surgery, patients' age and postoperative rehabilitation are major factors that affect the result.

关 键 词：经肱二头肌 正中神经 屈肘功能 移位 束支 肌支 肌皮 重建 手术适应证 臂丛神经 损伤类型 1995年 手外科学会 中华医学会 根性撕脱伤 神经功能 神经纤维 术后随访 功能评定 部分损伤 手术方法 损伤原因 间隔时间 功能锻炼 

分 类 号：R658[医药卫生—外科学]