健侧C7神经根移位治疗儿童臂丛根性撕脱伤  

Contralateral C7 transfer for treatment of brachial plexus root avuisions in children： a report of 12 cases

作　　者：陈亮[1] 顾玉东[1] 胡韶楠[1] 傅阳[1] 

机构地区：[1]复旦大学华山医院手外科,上海200040

出　　处：《中华骨科杂志》2008年第3期207-211,共5页Chinese Journal of Orthopaedics

基　　金：国家973项目资助（2003CB515305）

摘　　要：目的 回顾性调查健侧C7神经根移位术在儿童臂丛根性撕脱伤中应用的疗效及特点。方法对12例分娩或其他创伤引起的儿童臂丛根性撕脱伤患者应用健侧C7神经根合并其他神经移位术进行修复。通过带尺侧上副血管蒂的尺神经移植修复正中神经4例，桡神经1例，同时修复肌皮神经肱二头肌支和正中神经4例；通过3-4股游离腓肠神经移植修复上干或外侧束3例。5例手术一期完成，7例二期完成。结果随访至少21个月，平均42个月。全部病例均得到较好的感觉恢复（≥S3，MRC）。10例得到了明显的运动功能改善（≥M2^＋，改良MRC）。7例所获得的运动与感觉功能几乎不伴有健肢的同步兴奋，这些手术的受体神经均为支配肩、肘部的神经或肌皮神经肱二头肌支与正中神经同时接受移位。健肢除轻微的感觉异常外，2例婴儿还出现短暂的肩外展减弱。结论健侧C7神经根移位对儿童臂丛根性撕脱伤疗效肯定且对健肢安全。在一定条件下，一期与二期手术疗效基本相同。将动力神经移位于不同受体神经有助于改善功能恢复的质量。Objective To retrospectively determine the risks and benefits of contralateral C7 transfer to treat brachial plexus root avulsions in infants and children. Methods In 12 cases with root avulsions of the brachial plexus due to obstetric or other traumatic causes, the common trunk of the contralateral C7 root was transferred to the median nerve in 4, to the radial nerve in 1, and to both biceps nerve and medial part of the median nerve in 4 cases, as bridged by the ipsilateral ulnar nerve graft based on superior ulnar collateral vessels; it was transferred to upper trunk or lateral cord in 2 and its posterior division transferred to the anterior division of the upper trunk in 1 case, as bridged by 3 or 4 strands of conventional nerve grafts. The operation was performed in one stage for 5 and in two stages for 7 cases, depending on the blood supply for the ulnar nerve graft. Measurements for nerve regeneration before the second-stage procedure included SSEP and Tinel＇s sign evaluated along the nerve graft every 3 months. On reaching the axilla of the affected side, the regenerating nerve was then coapted to the recipient nerve. Sensory recovery after surgery was evaluated using the British Medical Research Council （MRC） Grading System （S0-4） and motor recovery was assessed with our modified MRC system. Results All patients were followed for a mean of 42 months, with the minimum of 21 months. Significant sensory function （≥S3） was gained in all of the cases, significant motor function （≥M2^＋） was obtained in 10 of the 12 cases. Seven of 12 children had little synchronous motion and sensibility of the donor limb, and these were mainly seen in patients with repair of nerves innervating shoulder and （or） elbow or of both the biceps and median nerves, while 5 children had significant synchronous motion and （or） sensibility. Besides slight damage to the sensory function of the median nerve, 2 infants had also temporarily reduced shoulder abduction on the healthy side. Conclusion For contral

关 键 词：臂丛 创伤和损伤 儿童 移植 

分 类 号：R726.5[医药卫生—儿科]