膈神经与肋间神经移位修复臂丛神经根性撕脱伤  

Phrenic nerve transfer versus intercostal nerve transfer for the repair of brachial plexus root avulsion injuries

作　　者：阿不地合比尔.阿不拉 李平[2] 依力哈木江.吾斯曼 艾合买提江.玉素甫[2] 

机构地区：[1]新疆维吾尔自治区人民医院小儿外科,新疆维吾尔自治区乌鲁木齐市830000 [2]新疆医科大学第一附属医院显微修复重建外科,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《中国组织工程研究》2016年第51期7660-7665,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81360270)~~

摘　　要：背景:肋间神经移位和膈神经移位已是治疗肘关节屈曲功能的主要方法,而有些臂丛神经根性撕脱伤患者两种术式均可适用,在这种情况下应该优选哪种修复方式一直是学者们讨论的难题。目的:观察膈神经移位至臂丛神经上干前股和肋间神经移位至肌皮神经修复臂丛神经根性撕脱伤的疗效。方法:臂丛神经根性撕脱伤患者20例,其中膈神经移位至臂丛神经上干前股9例(膈神经移位组),肋间神经移位至肌皮神经11例(肋间神经移位组),修复后均获得15-36个月的随访。观察两组患者的切口长度、术中出血量及操作时间并分别进行记录;观察两组患者肱二头肌肌力及肘关节屈曲角度的恢复情况。按中华医学会手外科学会制定的"上肢周围神经功能评定的试用标准"对肌皮神经的功能恢复进行评价,并计算其优良率,评价2种修复方式的治疗效果。结果与结论:1膈神经移位组优良率为67%,肋间神经移位组优良率为64%,两组优良率对比差异无显著性意义(P>0.05);2膈神经移位组切口小,出血量少,操作时间短;3膈神经移位组恢复不理想2例,肋间神经移位组恢复不理想3例;4结果表明,2种修复方式对臂丛神经根性撕脱伤患者效果良好,能有效恢复屈肘功能;膈神经移位在切口、出血量及操作时间等方面有优势。BACKGROUND：Phrenic nerve transfer and intercostal nerve transfer are the accepted surgery strategies for the treatment of brachial plexus root avulsion injuries;however, which surgery is more suitable for the repair remains inconclusive. OBJECTIVE：To observe the treatment outcomes of brachial plexus root avulsion injuries by transferring the phrenic nerve to the anterior division of the upper trunk of brachial plexus and the intercostal nerve to the musculocutaneous nerve. METHODS：Twenty patients with brachial plexus root avulsion injuries were included. Among them, 9 were treated with phrenic nerve transfer to the anterior division of the upper trunk of brachial plexus （phrenic nerve transfer group）, and 11 were treated with intercostal nerve transfer to the musculocutaneous nerve （intercostal nerve transfer group）. Postoperative fol ow-up ranged from 15 to 36 months. Incision length, blood loss, and operation time were recorded. Muscle strength of the biceps and elbow flexion angle were evaluated. The repair outcome was evaluated by assessing the functional recovery of musculocutaneous nerve according to the criteria issued by the Branch of Hand Surgery of Chinese Medicine Association, and the excel ent and good rate was calculated. RESULTS AND CONCLUSION：The excel ent and good rate was 66.7%and 63.6%, respectively, in phrenic nerve transfer group and intercostal nerve transfer group, which is not significantly different between both groups （P〉0.05）. Smal er length of operation incision, reduced blood loss, and shorter operation time were found in the phrenic nerve transfer group. Two and three patients in bad recovery were in phrenic nerve transfer and intercostal nerve transfer groups, respectively. These findings suggest that the two kinds of surgery strategies for the repair of brachial plexus root avulsion injuries can obtain good results in the functional recovery of elbow flexion. Phrenic nerve transfer exerts superiorities in operation incision, blood loss and operation time.

关 键 词：膈神经 臂丛损伤 组织工程 组织构建 肋间神经 神经移位术 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]