颈7神经根后股与副神经移位吻合重建斜方肌功能  

TRANSPOSITIONAL ANASTOMOSIS OF C_7 POSTERIOR ROOT AND SPINAL ACCESSORY NERVE TO RECONSTRUCT THE TRAPEZIUS MUSCLE FUNCTION

作　　者：孙坚[1] 李军[1] 蒋继党[1] 邱蔚六[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颌面外科,上海200011

出　　处：《中国修复重建外科杂志》2005年第11期890-893,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：上海市教育委员会资助项目(S990203)~~

摘　　要：目的探讨一种根治性颈淋巴清扫术(radicalneck dissection,RND)中采用神经移位吻合改善术后肩功能的方法。方法1999年3月～2001年2月,10例需行RND的患者,行RND时保留远颅端至斜方肌前缘的副神经,长度>3cm,待RND完成后,解剖分离出C7神经,并将其后股切断,长度3～5cm,在无张力下行两神经端端吻合。患者在术前和术后1、6及12个月行临床的斜方肌功能客观评价及肌电检测。结果经C7神经根后股与副神经移位吻合后,各部肌电恢复率1、6及12个月分别为上部9.8%、68.9%、73.5%;中部4.7%、73.6%、69.4%;下部6.2%、70.5%、70.3%;7例患者上臂外展超过90°,上肢平均最大外展角度超过95°,肌萎缩较轻,均为1～2级,肩外展受限2级7例,3级3例。结论RND中采用C7神经根后股与副神经移位吻合能较好地重建斜方肌功能。供、受区位于同一术区内,仅有一个吻合口,减少手术创伤。C7神经根后股的切断对手臂运动及感觉功能无影响。Objective To introduce a new approach of neurotization to treatment of the shoulder syndrome after the radical neck dissection by using transpositional anastomosis of C7 posterior root and the spinal accessory nerve to reconstruct the function of trapezius muscle. Methods From March 1999 to February 2001, 10 patients underwent the neurotization during the radical neck dissection. In the operation, theapo cranial part of spinal accessory nerve was preserved from the trapezius muscle （〉3. 0 cm in length） and anastomosed to C7 posterior root. Objective physical examinations and electromyograplay were conducted before and after operation. One, 6 and 12 months after operation the trapezius muscle function after the transpositional anastomosis was evaluated. Results ＇One, 6 and 12 months after operation, the recovery rates of each part were as follows： 9.8%, 68.9% and 73.5% in upper partr; 4.7%, 73.6% and 69.4% in middle part; and 6.2%, 70.5% and 70.3% in lower part. The range of abduction motion of upper arm in 7 cases （70%） exceeded 90%. The mean maximal abduction angle was more than 95%. Evaluation of the shoulder function showed that myoatrophy was mild and the disability of abduction was classified as grade Ⅱ in 7 cases and grade Ⅱ in 3 cases. Conclusion Transpositional anastomosis of the C7 posterior root to the spinal accessory nerve after radical neck dissection can well reconstruct the function oftrapezius muscle. This approach provides awide indication in comparison with the functional neck dissection without impairment of arm function after the cutting of C7.

关 键 词：颈7神经 副神经 吻合 根治性颈淋巴清扫术 肩功能 

分 类 号：R739.8[医药卫生—肿瘤]