健侧C7神经经椎体前通路移位的并发症及防治对策  

Prevention and management of the complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury

作　　者：王树锋[1] 李玉成[1] 栗鹏程[1] 王海华[1] 褚寅[1] 薛云皓[1] 胡琪[1] 赵俊会[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》2010年第8期758-763,共6页Chinese Journal of Orthopaedics

摘　　要：目的 分析健侧C7神经经椎体前通路移位修复臂丛神经损伤相关并发症的发生原因,并提出防治方法 .方法 自2002年2月至2009年8月,共完成425例健侧C7神经经椎体前通路移位术,男379例,女46例;年龄3个月～56岁,平均21岁.创伤性臂丛神经损伤401例,分娩性臂丛神经损伤24例.健侧C7神经自干平面切断15例,将前后股向远端做干支分离后在其远端切断410例.将并发症分为与椎体前通路制备、与健侧C7神经切取及围手术期其他严重并发症.结果 并发症发生率为5.18%（22/425）.与椎体前通路制备相关的并发症：椎动脉损伤0.47%（2/425）,喉返神经牵拉伤致声音嘶哑1.18%（5/425）,进食时健侧上肢麻木与疼痛0.94%（4/425）.与健侧C7神经切取相关的并发症：健侧伸指、伸拇功能障碍0.94%（4/425）,健侧上肢术后出现严重疼痛0.71%（3/425）,健侧出现Horner征0.47%（2/425）,C7神经根错切0.24%（1/425）.其他围手术期严重并发症0.24%（1/425）,1例患者术后第2天出现脑干栓塞症状,逐渐出现呼吸、循环衰竭,术后第38天死亡.结论 健侧C7神经经椎体前通路移位安全.椎动脉损伤的发生率虽然很低,但其是椎体前通路移位的严重并发症,显露椎动脉起始段后,直视下进行操作是防止此并发症的有效方法.Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years （range, 3 months to 56 years）. The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%（22/425）. The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner＇s sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route.

关 键 词：臂丛 神经移位 手术后并发症 

分 类 号：R651.3[医药卫生—外科学]