健侧C7神经移位与患侧下干直接吻合重建屈指功能的初步研究  

The primary clinical study of direct anastomosis of contralateral C7 transfered through the prespinal route with lower trunk in patient with brachial plexus root avulsion

作　　者：王树锋[1] 栗鹏程[1] 褚寅[1] 陆健[1] 李玉成[1] 潘勇卫[1] 薛云皓[1] 胡琪[1] 田光磊[1] 

机构地区：[1]北京积水潭医院手外科,100035

出　　处：《中华骨科杂志》2007年第6期438-441,共4页Chinese Journal of Orthopaedics

摘　　要：目的观察健侧C7神经经椎体前通路移位与患侧下干直接吻合术后患手屈指功能恢复的情况。方法将健侧C7神经根的前后股游离至最远端后切断。显露并游离患侧臂丛神经下干及内侧束，切断下干后股及胸前内侧神经。将正中神经、尺神经及前臂内侧皮神经自内侧束的起始处游离到上臂中段，以增加下干向近端移位的距离。经椎体前通路将健侧C7神经牵至患侧，患肩前屈、内收，上提患侧下干并与健侧C7神经吻合。临床应用30例，26例获得7个月以上的随访，男24例，女2例；年龄≥18岁患者20例，〈18岁患者6例。全臂丛神经撕脱伤23例，中、下干撕脱伤3例；伤后到手术时间3-13个月，平均5个月。结果75％（15／20）的成年患者（≥18岁）在术后11-14个月屈指肌力达到2级；67％（4／6）的未成年患者（〈18岁）在术后7-10个月，屈指肌力达到2级。结论健侧C7神经与患侧下干直接吻合，较传统手术方法缩短了神经再生的距离及减少了一个吻合口，可提高其重建屈指功能效果。Objective To observe the primary result of direct anastomosis of contralateral C7 transfered through the prespinal route with lower trunk in patient suffered brachial plexus root avulsion. Methods The length of contralateral C7 nerve root was elongated 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.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 mot which were severed at the lateral margin of anterior scalenus, and then the dorsal division and anterior medial pectoral nerve of lower trunk were severed. The median nerve, ulnar nerve and medial antebrachial cutaneous nerve were identified from its beginning and dissected distally continue to the midpoint of upper ann, and lateral head of the median nerve was severed so that the lower trunk, medial cord and median nerve, ulnar nerve and medial antebrachial cutaneous nerve can be fully mobilized. Anteriorly flexion and adduction of the shoulder and flexion elbow at 90°, this can allow considerable length to be gained when pulling the lower trunk proximally, direct anastomosis of contralateral C7 with lower trunk was performed. From May 2004 to September 2005, 30 patients with brachial plexus nerve mot avulsion were repaired with this procedure, 26 cases including 24 males and 2 females were followed up more than 7 months. The interval from injury to operation ranged 3 to 13 months with a mean of 5 months. Results 15 of the 20 cases in adult group with the age more than 18 years began to recover the motivation of finger flexion during the period of 11-14 months after the operation; 4of the 6 cases in the group with age less than 18 years began to recover the motivation of finger flexion during the period of 7-10 months after operation. Conclusion The direct anastomosis of contralateral C7 with lower t

关 键 词：臂丛 颈丛 创伤和损伤 颈椎 

分 类 号：R686[医药卫生—骨科学]