膈神经移位修复下干后股重建臂丛撕脱伤伸肘及伸指功能的中期随访  

Medium term follow-up of phrenic nerve transfer to the posterior division of lower trunk to recover elbow and finger extension in patients with brachial plexus root avulsion

作　　者：王树锋[1] 栗鹏程[1] 薛云浩[1] 李玉成[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》2012年第9期855-861,共7页Chinese Journal of Orthopaedics

摘　　要：目的观察膈神经移位修复下法国国会干后股重建臂丛神经撕脱伤伸肘、伸指、伸拇功能的效果。方法2005年6月至2008年12月采用膈神经移位修复下干后股重建43例臂丛神经撕脱伤患者的伸肘及伸指功能，男36例，女7例；年龄4-44岁，平均（23．5±9．9）岁。受伤至手术时间1-12个月，平均（3．7±1．9）个月。其中全臂丛神经撕脱伤32例，中下十撕脱伴上千部分损伤或正常5例，C6-T1神经根撕脱伴C，椎孔外断裂或部分损伤6例。取锁骨上、下臂丛神经探查联合切口，显露下干后股，向近端干支分离后切断。将后侧束、桡神经向远端游离，切断后侧束的其他分支。将下干后股、后侧束及桡神经上提，膈神经存胸廓上口内切断，将膈神经与下十后股吻合。膈神经与下干后股直接吻合33例，通过腓肠神经桥接10例。结果全部病例获得随访，随访时间36-73个月，平均（39．7±7．1）个月。伸肘、伸指、伸拇肌力达到3或以上的比例分别为81．6％、41．9％、39．5％。结论膈神经移位修复下干后股，其伸肘功能恢复满意，伸指、伸拇功能的恢复仍需进一步改善。Objective To observe effect of phrenic nerve transfer to the posterior division of lower trunk （PDLT） for recovering elbow and finger extension in patients with braehial plexus root avulsion. Meth-ods From June 2005 to December 2008, 43 patients with brachial plexus root avulsion were treated with phrenic nerve transfer to PDLT to recover elbow and finger extension. There were 36 males and 7 females, aged from 4 to 44 years （average, 23.5±9.9 years）. The interval from injury to operation ranged from 1 to 12 months （average, 3.7±1.9 months）. There were 32 cases of total nerve roots avulsion, 5 cases of middle and lower trunk avulsion accompanied with upper trunk normal or partial injury, and 6 cases of C6 to T~ nerve root avulsion accompanied with C5 nerve root rupture or partial injury. The normal function of the phrenic nerve in the injured side should be proved preoperatively by radiographic and electromyographic examina- tion. The entire braehial plexus in injured side was exposed through the combined incision. The posterior di-vision of lower trunk was identified and severed as proximal as possible, and the posterior cord and radial nerve were dissociated distally until to the level of midpoint of humerus. Then the branches of the posterior cord except the radial nerve were sectioned. Direct anastomosis of the phrenic nerve and PDLT was per-formed in 33 patients, and indirect anastomosis through bridge grafting using sural nerve was performed in remaining 10 cases. Results All patients were followed up for 36 to 73 months （average, 39.7±7.1 months）. The percentage of muscle strength ≥grade 3 in elbow, finger and thumb extension was 81.6%, 41.9% and 39.5%, respectively. Conclusion Satisfactory functional recovery of elbow extension had been achieved af-ter the phrenic nerve transfer to the PDLT in patients with brachial nerve root avulsion injury, however, the functional recovery of finger and thumb extension was not as satisfactory as anticipated.

关 键 词：臂丛 创伤和损伤 膈神经 桡神经 

分 类 号：R651.3[医药卫生—外科学]