多组神经移位治疗臂丛C5～C7根性撕脱伤重建肩外展及屈肘功能  

Multiple nerve transfer to rebuilt the shoulder abduction and elbow flexion after the avulsion of C5-C7 nerve roots

作　　者：聂铭博[1] 鲍远[1] 张滋洋[1] 康皓[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《骨科》2016年第3期145-148,共4页ORTHOPAEDICS

基　　金：国家自然科学基金(81472106)

摘　　要：目的观察联合应用多组神经移位治疗臂丛上、中干根性撕脱伤重建肩外展及屈肘功能的临床效果。方法我科于2012年4月至2014年4月收治臂丛上、中干根性撕脱伤患者16例,采用副神经斜方肌肌支移位修复肩胛上神经、桡神经肱三头肌长头支移位修复腋神经肌支及尺神经部分束支移位肌皮神经（Oberlin术式）,联合修复臂丛上、中干根性撕脱伤,以恢复肩外展及屈肘功能。术后随访采用臂肩手功能障碍（the disabilities of the arm,shoulder and hand,DASH）评分表评估疗效。结果 16例患者中有14例术后得到随访。随访时间为24~28个月（平均为25个月）,患者肩关节外展恢复至75°~90°,恢复时间为9.0~18.0个月（平均为14.0个月）。屈肘恢复至100°~160°,恢复时间为4.0~7.5个月（平均为5.8个月）。DASH评分为8.0~16.0分,平均为14.6分。结论使用多组神经移位联合治疗臂丛上、中干损伤,可较好恢复肩外展及屈肘功能,尺神经部分束支移位修复肌皮神经肱二头肌支对手内在肌功能无明显影响。Objective To observe the curative effect of the multiple nerve transfer to cure the disabili-ty of shoulder abduction and elbow flexion after the avulsion of C5-C7 nerve roots. Methods Sixteen cases ofthe avulsion of C5-C7 nerve roots were subjected to multiple nerve transfer to rebuilt the shoulder abductionand elbow flexion during April 2012 to April 2014. We transferred the accessory nerve to suprascapular nerve,the anconeus longus branch of radial nerve to the axillary nerve and ulnar nerve partial fascicle to the musculo-cutaneous nerve（Oberlin transfer）, respectively. The curative effect was estimated by the DASH questionnaire.Results Fourteen out of 16 patients had been successfully followed up. The mean period of follow-up was 25months（ranging from 24-28 months）. The range of shoulder abduction was 75°-90° and the average recoverytime was 14.0 months（ranging from 9.0-18.0 months）. The range of elbow flexion was 100°-160° and the aver-age recovery time was 5.8 months（ranging from 4.0-7.5 months）. The mean value of DASH score was 14.6（rang-ing from 8.0-16.0）. Conclusion The multiple nerve transfer can successfully rebuilt the shoulder abductionand elbow flexion after the avulsion of C5-C7 nerve roots and the ulnar nerve partial fascicle to the musculocuta-neous nerve will do no harm to the function of intrinsic muscles in hand.

关 键 词：臂丛 神经移位 周围神经 尺神经 

分 类 号：R688[医药卫生—骨科学]