产瘫A型Ⅳ度伤手术技巧  

Surgical techniques for type a Ⅳ degree obstetrical palsy

作　　者：张咸中[1] 周学军 

机构地区：[1]暨南大学附属深圳华侨医院手外科,广东深圳518111 [2]东辽县医院放射科,吉林辽源361200

出　　处：《实用手外科杂志》2014年第3期243-244,246,共3页Journal of Practical Hand Surgery

摘　　要：目的 总结应用显微外科技术治疗产瘫上干根性撕脱伤（A型Ⅳ度）42例手术技巧.方法 1980年2月-2010年2月,根据自行设计的手术方法对42例产瘫A型Ⅳ度伤进行手术治疗.解脱被撕脱神经根远端包块必须从锁骨后方团块的外后侧着手剥离,严禁从团块的内侧开始.用14 cm弯血管钳和手指把“挥鞭样”力导致的卷埋的神经根包块从锁骨后缘解脱出来,并松解中干.最后用丛内移位、丛外移位或患侧C7移位方法解决动力神经.结果 本组42例产瘫A型Ⅳ度伤术后取得75％优良率,并且无一例副损伤.结论 本文总结出产瘫A型Ⅳ度伤术中判断标准及安全探查解脱神经根远端团块的手术技巧,该手术技巧是切实可行、安全可循的手术实用方法.Objective To summarize the results of surgical techniques from 42 cases by using a microsurgical technique to cure upper trunk avulsion injury of obstetrical palsy （Type A Ⅳ Degree）.Methods From February 1980 to February 2010,42 cases,diagnosed as Type A Ⅳ Degree Obstetrical Palsy,used surgical techniques designed by myself.The technique requires the avulsed far-end mass on nerve roots be peeled off starting from the back and outside of the mass at the rear end of the clavicle.Peeling it off from the inner side of the mass is strictly prohibited.In doing so,firstly,a 14 cm curved vessel forceps and fingers were used to whiplash the curled and buried mass on nerve roots to disengage from the rear end of the clavicle.Secondly,the middle trunk was loosen and released.Finally,with the methods of intra-plexus nerve transfer,extra-plexus nerve transfer and C7 transfer to deal with motor nerves.Results After 42 cases of operation on patients diagnosed with Type A Ⅳ Degree Obstetrical Palsy,an eligible rate of 75％ was achieved,without any case of collateral damage.Moreover,three standards on diagnosing Type A Ⅳ Degree Obstetrical Palsy during operation and surgical techniques on safely disengaging a far-end mass on nerve roots were worked out.Conclusion The surgical techniques for Type A Ⅳ Degree Obstetrical Palsy are workable and safe.The judgment standards for operation of Type A Ⅳ Degree Obstetrical Palsy are illustrated.

关 键 词：产瘫 A型Ⅳ度 手术技巧 

分 类 号：R657.4[医药卫生—外科学]