臂丛神经上干损伤后肩外展功能重建体会  

The methods of restoration of shoulder abduction after the C5,C6 root avulsion of brachial plexus

作　　者：徐房添[1] 姬广林[1] 高辉[1] 华云[2] 刘午阳[1] 赖光松[1] 黄为民[1] 吴东保[1] 艾芳[1] 

机构地区：[1]赣南医学院第一附属医院骨科,江西赣州341000 [2]赣南医学院肌电图室,江西赣州341000

出　　处：《赣南医学院学报》2010年第3期389-390,共2页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨臂丛神经上干根性撕脱伤后肩外展功能重建的方法。方法:对7例臂丛上干根性撕脱伤,术前EMG、MRI及全面的理学检查确诊后,或者术中经过神经探查及术中肌电检测确诊后,施行新的神经移位术:副神经移位至肩胛上神经,桡神经肱三头肌长头肌支移位至腋神经的三角肌支,同时重建三角肌和冈上下肌的功能。术后早期行理疗、功能锻炼及神经营养药物等综合措施。结果:术后经过6～28个月的随访,肩外展、外旋、上举功能恢复满意。5例随访超过1年的患者,目标肌力均达M3以上,随访少于8个月的2例患者,目标肌力也达M1～2。结论:对臂丛上干根性撕脱伤确诊后,桡神经肱三头肌长头肌支及副神经同时移位是重建肩外展、外旋等功能有效合理的治疗方法,较之单一的肩胛上神经或腋神经重建,增加了肩外展功能的恢复效率。Objective：To investigate the methods of restoring shoulder abduction after the C5,C6 root avulsion of brachial plexus. Methods ： Seven patients with the complete C5, C6 root avulsion, aging 18 - 37 years and with a mean 4.5 months interval of injury and repair, diagnosing preoperatively by EMG,MRI and physical examination, or by surgical exploration and intra-operative electrophysiological monitoring, were surgically treated to restore shoulder abduction with the fonowing procedures. The accessory nerve was transferred to the suprascapular nerve, the nerve branch to the long head of triceps muscle from radial nerve to the deltoid branch of axillary nerve. Postoperatively comprehensive measures, such as physical therapy, active functional training and nerve-nutrition drug etc. , were put into practice. Results： All patients were followed up from 6 months to 28 months （ 14 months on average）, and the recovery results of Shoulder abduction, superduction and external rotation are excenent. The target muscle power recover to M3 or better in 5 cases with a follow-up period exceeding 1 year, whereas in 2 eases whose follow-up less than 8 months, the target muscle power recover to M1-2. Conclusion：Restoring shoulder abduction by transferring the accessory nerve to the suprascapular nerve and the nerve branch to the long head of triceps muscle from radial nerve to the deltoid branch of axiUary nerve is reasonable and effective after diagnosed as the C5, C6 root avulsion of brachial plexus.

关 键 词：臂丛 上干损伤 神经移位 肩外展功能重建 

分 类 号：R651.3[医药卫生—外科学]