膈神经端侧缝合移位术后呼吸功能的随访研究  

Respiratory function after phrenic nerve transfer by end-to-side neurorrhaphy

作　　者：沈云东[1] 郑谋雄 徐文东[1] 徐建光[1] 顾玉东[1] 

机构地区：[1]复旦大学附属华山医院手外科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医学神经生物学国家重点实验室,上海200040

出　　处：《中华手外科杂志》2014年第1期1-4,共4页Chinese Journal of Hand Surgery

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

摘　　要：目的研究臂丛神经根性撕脱伤患者膈神经端侧缝合移位术后呼吸功能的变化情况。方法5例臂丛神经根性撕脱伤患者接受了膈神经端侧缝合移位至臂丛上于前股或肌皮神经，术后35个月通过肺功能、胸部动态透视及神经电生理检查呼吸功能及术侧膈肌的功能。结果术后所有患者用力呼气量（FVC）、IS用力呼气量（FEVI）和肺总量（TCL）与术前水平相同，术后x线片及胸透显示术侧膈肌均未出现抬高或活动度下降，膈神经传导潜伏期平均延长2．9ms，动作电位波幅平均下降32．4％。此外，5例患者肱二头肌都获得了神经再支配，其中3例患者的肱二头肌肌力达到№或地以上。结论膈神经端侧缝合移位术恢复屈肘功能的同时呼吸功能不受影响，对于需要保留膈肌功能的患者是一种可供选择的替代方案。Objective To investigate changes in respiratory function of patients with brachial plexus avulsion injuries （BPAIs） after phrenic nerve transfer by end-to-side neurorrhaphy. Methods A series of 5 patients with BPM underwent phrenic nerve transfer to anterior division of the upper trunk or to the musculocutaneous nerve by end-to-side neurorrhaphy to reconstruct elbow flexion. Pre- and post-operative pulmonary function tests, chest fluoroscopy and phrenic nerve conduction studies were performed to evaluate the respiratory function and function of diaphragm on the affected side. Results The forced vital capacity（FVC）, forced expiratory volume in one second （FEV1） and total lung capacity （TLC） measured 35 months postoperatively were not significantly different from the preoperative pulmonary function measurements in all the patients. Chest X-ray and fluoroscopy showed neither elevation nor reduced movement of diaphragm on the operated side. Phrenic nerve conduction study revealed an average of 2.9 ins increase in latency and 32.4% decrease in action potential amplitude when compared to preoperative values. In addition reinnervation of the biceps was successful in all tile patients. Biceps muscle strength reached M3 or higher in 3 patients. Conclusion Phrenic nerve transfer by end-to-side neurorrhaphy can lead to functional biceps recovery without compromising pulmonary function. It can be an alternative pmcedttre for patients whose diaphragm function needs to be preserved.

关 键 词：膈神经 神经移位 呼吸功能 

分 类 号：R651.3[医药卫生—外科学]