膈神经移位至臂丛上干前股的临床应用及疗效分析  

Clinical application and efficacy of phrenic nerve transferring to the anterior division of upper trunk of brachial plexus for treatment of the brachial plexus injury

作　　者：刘叶[1] 范顺武[1] 贺长清[2] 

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016 [2]郑州大学第一附属医院骨科,郑州450052

出　　处：《中国临床解剖学杂志》2006年第3期344-346,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:报道膈神经移位至臂丛上干前股的临床应用,分析疗效欠佳的原因并探讨应对措施。方法:回顾自1999年3月～2005年2月行膈神经移位至臂丛上干前股术式的38例患者手术情况,对肌皮神经恢复情况进行随访并功能评定,并对影响疗效的各因素进行分析以探讨相应的防治措施。结果:获15个月以上随访患者共29例,优良率为62.1%,功能恢复优良组与非优良组患者的病程及牵拉伤比率存在显著性差异(P<0.05)。再手术探查发现手术失败的原因有:神经吻接口张力大、存在臂丛的组成变异及多段损伤等。基于神经解剖特点,作者针对减低膈神经吻接口张力提出了手术改良措施并取得满意的疗效。结论:影响该术式疗效的因素有多种,严格把握手术适应症及术中仔细探查是提高治疗效果的关键;通过术式改良可有效降低神经吻接口张力,有助于神经恢复。Objective： To analyze the causes of less approved results for patients with phrenic nerve transfer to upper trunk of brachial plexus, and to suggest some preventive measures for getting a better clinical outcome. Moiling：Retrospective analysis was carded out in 38 patients who had been operated with phrenic nerve transfer to upper trunk of brachial plexus from Mar.1999 to Feb.2005. Six cases of these patients were performed reoperations because their discouraged results. The recovery state of musculocutaneous nerve was followed up and its function was evaluated according to the probation criterions established by the hand surgery institute of Chinese Medical Association. Results： 29 patients had been followed up over 15 months. There were 18 cases belonged to the good clinical result group and 11 cases poor one. Comparing with two groups, the course of diseases and the rate of traction injury were statistically different（P〈0.05）. Through surgical exploration, some possible causes leading to poor clinical result were found： high tension at nerve commissure, multiple level brachial plexus injuries and the anatomical variation of brachial plexus. A modified measu（e to relieve the tension at nerve commissure was attempted in some cases and it was proved to be effective. Conclusions：Many factors may influence the outcome of phrenic nerve transfer to upper trunk of brachial plexus which can be abolished by the careful selection of operative indications and proper application of the modified measure.

关 键 词：膈神经 神经移位 臂丛 上干 随访 

分 类 号：R651.3[医药卫生—外科学]