肋间神经移位修复桡神经肱三头肌肌支的长期随访疗效  

Long-term results of intercostal nerve transfer to triceps branch of the radial nerve

作　　者：赵沛[1,2] 劳杰[3] 赵新[3] 高凯鸣[3] 

机构地区：[1]复旦大学附属华山医院手外科,上海200040 [2]重庆医科大学附属第一医院 [3]卫生部手功能重建重点实验室 上海市周围神经显微外科重点实验室

出　　处：《中华手外科杂志》2013年第4期198-200,共3页Chinese Journal of Hand Surgery

基　　金：卫生部国家临床重点专科建设项目（2010）;上海市周围神经显微外科重点实验室基金项目（08DZ2270600）

摘　　要：目的分析探讨肋间神经移位修复桡神经肱三头肌肌支的长期随访疗效。方法回顾性随访2004年至2008年于我院行肋间神经移位修复桡神经肱三头肌肌支的23例患者术后肱三头肌肌力的恢复情况。其中16例患者诊断为全臂丛神经根性撕脱伤，7例患者诊断为C5-C7根性撕脱伤合并下干损伤（非根性撕脱伤）。患者受伤至接受肋间神经移位手术的时间间隔为5．7个月；平均随访时间48．7个月。结果肱三头肌肌力恢复优良率（肌力恢复至飓及以上）为39．1％，肌力恢复至M2的患者占30．4％，肌力恢复至M1及以下占30．5％。C5-C7根性撕脱伤合并下干损伤患者肱三头肌肌力恢复优于全臂丛神经根性撕脱伤患者。使用2根或2根以上的肋间神经移位修复肱三头肌肌支术后疗效未见明显差异。结论肋间神经移位修复桡神经肱三头肌肌支可使肱三头肌得到一定程度的恢复。Objective To evaluate the long-term outcomes of restoring elbow extension by transferring intercostal nerves to the triceps branch of the radial nerve. Methods A retrospective study of 23 cases of brachial plexus injuries treated with intercostal nerve transfer to the triceps branch of the radial nerve at our hospital between 2004 and 2008 was conducted. Recovery of triceps muscle power and elbow extension was analyzed. Among these patients 16 had complete brachial plexus root avulsions while 7 had C5 to C7 root avulsions with lower tnmk non-avulsion lesions. The mean duration between injury and intercostal nerve transfer was 5.7 months. The mean follow-up time was 48.7 months. Results Good or excellent motor recovery of the triceps （muscle power over M3） was achieved in 39.1% of the patients. Triceps strength recovered to M2 in 30.4% of the patients and to M1 or lower in 30.5% of the patients. Patients with C5 to C7 root avulsion along with C,s to TI traction had better recovery than those with complete brachial plexus root avulsions. There was no significant difference in treatment outcomes when 2 or more than 2 intercostal nerves were used for neurotization. Conclusion Intercostal nerves transfer to the triceps branch of the radial nerve can restore triceps function to ~me extent.

关 键 词：臂丛 肋间神经 随访研究 肱三头肌肌支 神经移位 

分 类 号：R651.3[医药卫生—外科学]