多组神经部分束支移位重建臂丛神经上干损伤后肩肘功能  

Multiple nerve transfers for restoration of shoulder and elbow functions in brachial plexus upper trunk injury

作　　者：王德华[1] 张桂萍[2] 王增涛[1] 朱小雷[1] 刘志波[1] 孙文海[1] 

机构地区：[1]山东大学附属省立医院手足外科,济南250021 [2]山东中医药大学附属医院麻醉科

出　　处：《中华手外科杂志》2015年第3期215-217,共3页Chinese Journal of Hand Surgery

摘　　要：目的 采用多组神经部分束支就近移位至受区神经的方法,重建臂丛神经上干损伤后肩肘功能.方法 自2009年10月至2012年12月共收治6例臂丛神经上干损伤患者,分别行副神经到肩胛上神经、桡神经肱三头肌长头肌支到腋神经前支及尺神经部分束支到肱二头肌肌支等受区局部神经移位术.结果 6例患者术后均获得随访,时间为10个月至3年.术后4～6个月肩外展和屈肘功能均不同程度恢复.术后1年肩外展外旋及屈肘活动范围接近正常.1例患者术后出现环、小指感觉减退,观察1年症状明显减轻.结论 采用多组神经部分束支就近移位至受区神经的方法重建臂丛神经上干损伤后肩肘功能,具有操作简便、恢复时间短、手术效果可靠等优点,值得推广.Objective To reconstruct shoulder and elbow function in patients with upper tnunk brachial plexus injuries using multiple distal nerve transfers.Methods From October 2009 to December 2012,6 patients with upper trunk brachial plexus injuries were treated with simultaneous transfer of the spinal accessory nerve to the suprascapular nerve,triceps long head branch of the radial nerve to anterior branch of the axillary uerve,and partial ulnar nerve fascicle to biceps muscle branch.Results All 6 patients were follow-up for 10 months to 3 years postoperatively.Partial functional recovery of the shoulder and elbow joints was observed 4 to 6 months after the surgery.Shoulder abduction and external rotation,and elbow flexion were near normal one year postoperatively.Decreased sensation of the ring finger and little finger occurred in one patient which was relieved one year after the operation.Conclusion Multiple nerve transfer closer to the recipient nerves has such advantages as being a simpler procedure,faster functional recovery and reliable surgical outcomes.It is a worthy procedure for restoring shoulder and elbow functions in upper trunk brachial plexus injuries.

关 键 词：臂丛 神经移位 功能重建 

分 类 号：R658.206[医药卫生—外科学]