膈神经移位接上干前股的解剖与临床研究  

Anatomical and clinical study of phrenic nerve transfer to the upper trunk of brachial plexus

作　　者：董震[1] 成效敏[1] 徐杰[1] 顾玉东[1] 

机构地区：[1]上海医科大学附属华山医院手外科,200040

出　　处：《中华手外科杂志》2000年第2期102-104,共3页Chinese Journal of Hand Surgery

摘　　要：目的　通过对肌皮神经肱二头肌肌支的解剖学研究 ,为臂丛损伤后设计应用膈神经移接于臂丛上干前股恢复屈肘功能的新术式。方法　对 10具 2 0侧尸体上肢的肱二头肌肌支作逆行解剖 ,观察其在上干前股内的定位。对 2 1例臂丛损伤患者 ,将膈神经移接于上干前股 ,并观察其疗效。结果　解剖学研究 :肱二头肌肌支位于上干前股前外侧及前正中束组 ,其横截面积占上干前股横截面积的 3 4 %。 2 1例患者屈肘功能恢复的总有效率达 80 .95 % ,其中上中干型损伤的有效率达 87.5 % ,全臂丛损伤的有效率达 76.92 %。结论　该术式疗效满意 ,手术简单 ,创伤小 ,可在临床推广应用。Objective Based on the anatomical study of the muscle branch of the musculocutaneous nerve to the biceps brachii muscle, a new surgical procedure using phrenic nerve transfer to the upper trunk was designed for restoration of elbow flexion after brachial plexus injuries. Methods 20 upper extremities of 10 cadavers were used. The muscle branch of the musculocutaneous nerve to the biceps brachii muscle was dissected retrogradely. The location of the muscular branch in the anterior division of the upper trunk was observed. In 21 cases of brachial plexus injuries, the phrenic nerve was transferred to the appropriate part of the anterior division of the upper trunk. The treatment outcome was followed. Results The muscular branch to biceps muscle located at the antero lateral or antero middle portion of the anterior division of the upper trunk. The cross-sectional area of the muscle branch was 34 % of that of the anterior division of the upper trunk. The overall effective rate of elbow flexion was 80.95 %. The effective rate in the cases of upper middle trunk injury was 87.5 %, while that of total brachial plexus injury 76.92 %. Conclusions The surgical procedure can be advocated for clinical application in that it possesses such advantages as satisfactory outcome, simple manipulation, and minor trauma.

关 键 词：肌皮神经 臂丛神经 显微解剖 临床应用 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]