健侧颈_7神经根经椎体前路移位修复臂丛神经根性撕脱伤的疗效观察  

The contralateral C_7 transfer via prespinal route to repair the brachial plexus avulsion:A preliminary study on its clinical effect

作　　者：徐雷[1] 顾玉东[1] 徐建光[1] 徐文东[1] 陆九州[1] 林森[1] 沈云东[1] 沈浩[1] 韩栋[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海市200040

出　　处：《中华显微外科杂志》2007年第4期270-273,I0008,共5页Chinese Journal of Microsurgery

基　　金：上海市卫生局科研基金(044070);上海市科委基金:创新团队(04DZ19901)

摘　　要：目的探讨健侧颈_7神经根经椎体前路移位修复臂丛神经撕脱伤的最短通路及其安全性,并分析其应用指征和临床疗效。方法将健侧颈_7神经根自干股交界处或锁骨后束部起始部切断,近端游离至椎间孔,将前斜角肌切断,经椎体前食管后间隙,通过5～7股皮神经桥接或直接吻合,修复患侧上干或锁骨下外侧束和后束。临床修复8例,5例为全臂丛神经根性撕脱伤,3例为臂丛上中干根性撕脱伤伴下干部分损伤。结果5例患者术后1周内在咳嗽、进食时有轻度健侧手指麻木感,随后逐渐消失;2～3个月后患侧颈部扣击健侧手指出现麻木感,SSEP在术后3个月时均能引出,7个月时能引出支配肌CMAP,12个月时恢复了肩肘功能。结论切断双侧前斜角肌不仅可以缩短移值神经的长度,而且颈_7神经根翻转通路更通畅、安全,有利于神经再生和患肢功能恢复。锁骨上修复主要重建上干前股、上干后股、肩胛上神经功能;锁骨下修复时,主要重建外侧束加后束。Objective To investigate a shorter and safer route for contralateral C7 nerve root transfer. Methods Eight male patients were treated from Dec. 2005 to Nov. 2006. Their range of age was from 22 to 43 years with an average of 30 years. Five cases had total brachial plexus avnlsion. The operative delay was from 2 to 6 months （mean： 4 months）. The scalenns anterior muscle was transected before a prespinal ＆ retropharyngeal tunnel was made. The contralateral C7 nerve root was used to repair the upper trunk or the infraclavicular lateral cord and posterior cord of injured side via this route, using direct anastomosis or nerve grafting. Results The length of the harvested contralateral C7 nerve root was （ 4. 67 ± 0. 52 ） cm in the early 5 cases. The nerve graft was （6. 25 ±0. 35）cm long for repairing snpraclavienlar brachial plexus and （8. 56 ± 0. 45 ） cm long for repairing infraclavicular brachial plexus. The length of the harvested contralateral C7 nerve root averaged 6. 85cm in the other 3 cases, 2 of which had direct anastomosis to the residual nerve C5 and C6 nerve roots and the other used nerve graft of 3 cm in length. Transient contralateral sensory symptoms were reported in most patients. At 3 months followups, 6 patients had tingling sensation on the contralateral fingers with percussion on the injured cervical area. Ipsilateral SSEP could be recorded by stimulating at 2 cm above sternoclavicular joint on the injured side. At 7 months follow ups of 5 patients, CMAP could be recorded in biceps, deltoids and infraspinatus or triceps with stimulation at Erb＇ s point; However, no clinical movements was noticed. At 12 months follow ups of 3 patients, we could observe early motor and sensory function recovery of those patients to different extent. Conclusion Transection of anterior scalenus muscle shortens the length of the transfer route and allows more efficient nenrotization. The procedure is convenient and safe, provided certain precautions being used. The principal of contralateral Cv

关 键 词：臂丛 损伤 神经 移植 显微外科技术 

分 类 号：R651.3[医药卫生—外科学]