健侧颈_7神经移位与下干直接缝合的可行性研究  

Feasibility of direct anastomosis of contralateral C_7 transfered through prespinal route with lower trunk in patient with brachial plexus root avulsion

作　　者：王树锋[1] 胡琪[1] 潘勇卫[1] 

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《实用手外科杂志》2005年第2期67-69,F003,共4页Journal of Practical Hand Surgery

摘　　要：目的观察健侧颈7神经经椎体前通路移位与患侧下干直接缝合的可行性,为提高健侧颈7神经移位重建臂丛神经根性撕脱伤患者的屈指功能,寻找一种新术式。方法10具福尔马林固定的尸体标本,设定左侧为臂丛神经损伤侧,右侧为健侧。将健侧通过颈7神经根的前后股向远端进行干支分离,使其长度增加后再切断。经椎体前通路将健侧颈7向患侧颈部牵拉,测量其远端过颈7椎体中线的距离。患侧经锁骨上、下切口显露臂丛神经,将下干向近端游离至颈8、胸1神经根,在前斜角肌的外缘切断之。然后沿下干向远端游离至上臂中段。在患侧肩关节前屈、内收位,将下干经锁骨后向对侧颈部牵连,测量其过颈7椎体中线的距离。临床选择7例全臂丛神经撕脱伤患者,行健侧颈7神经经椎体前通路与患侧下干直接缝合。结果颈7神经根与前股和后股长度之和分别为(6.8±0.7)cm、(6.3±1.0)cm,前后股过颈7椎体中线的长度分别为(2.8±0.67)cm、(2.3±0.98)cm;患侧下干过颈7椎体中线的距离为(1.0±0.3)cm。临床应用7例均成功将健侧颈7与患侧下干直接缝合。结论健侧颈7神经经椎体前通路可直接与患侧下干进行缝合。Objective To observe the possibility of direct anastomosis of contralateral C7 transfered through the prespinal route with lower trunk in patient with brachial plexus root avulsion, in order to find a modified operative method that can improve the effect of contralateral C7 transfer to reconstruct the hand function of finger flexion.Methods Ten adult cadaver specimens were used for this study and the left brachial plexus was supposed as suffered side.The length of contralateral C7 nerve root was enlongated by dissecting its anterior and posterior division to the distal end, the C7 nerve root was severed and transferred to contralateral side through the prespinal route and the length of distal C7 nerve root passing the midline of C7 vertebral body was measured. The entire brachial plexus of suffered side was exposed through the union incision superior and inferior to the clavicle,The lower trunk was identified and dissected proximally to the C8 and T1 nerve root which were severed at the lateral margin of M.anterior scalenus,and then the lower trunk dissected distally continue to the midpoint of upper arm. Flexion of the should and elbow, and adduction of the arm across the chest wall allow considerable length to be gained when pulling the lower trunk proximally, the distance of proximal side of lower trunk passing the midline of C7 vertebra body was also measured.Results The average length of C7 nerve root plus anterior division was (6.8±0.7)cm, and C7 nerve root plus posterior division was (6.3±1.0)cm. Direct anastomosis of contralateral C7 transfered through the prespinal route with lower trunk in 7 patients with brachial plexus root avulsion was successfully performed.Conclusion The direct anastomosis of contralateral C7 transfered through the prespinal route with lower trunk in the patient with brachial plexus injury was feasible.

关 键 词：臂丛神经 创伤 下干直接缝合 颈椎 解剖学 健侧颈7 手术方式 

分 类 号：R651.3[医药卫生—外科学]