健侧颈7神经根经改良椎体前通路移位修复臂丛神经根性损伤  

Contralateral C7 nerve transfer via a modified prespinal route in repair of brachial plexus avulsion injuries

作　　者：杨勇[1] 王树锋[1] 栗鹏程[1] 薛云皓[1] 李文军[1] 李玉成[1] 

机构地区：[1]北京积水潭医院手外科,100035

出　　处：《中华手外科杂志》2017年第1期32-35,共4页Chinese Journal of Hand Surgery

基　　金：北京首都医学发展基金（209-18-25-03）

摘　　要：目的探讨健侧颈，神经根经改良的椎体前通路移位修复臂丛神经根性损伤的疗效。方法健侧颈，神经根经改良椎体前通路修复臂丛神经根性损伤患者200例，男183例，女17例；年龄4-59岁，平均（28．3±10．6）岁。受伤至健侧颈。神经根移位手术时间1-11个月，平均（3．7±1．6）个月。健侧颈，均经过改良的椎体前通路，即经过前斜角肌深面并通过食管-颈椎间隙移位至伤侧颈部。根据修复神经的不同将患者分为两组：A组为健侧颈，神经修复臂丛神经上干，共60例；B组为健侧颈，神经直接修复臂丛神经下干，共140例。A组术后肌力的检查包括三角肌、肱二头肌和胸大肌锁骨部；B组包括指屈肌、腕屈肌和肱二头肌。结果A组随访60-143个月，平均（90±13）个月；B组随访48-152个月，平均（86±15）个月。A组健侧颈，神经根分离长度平均为（6．7±0．8）cm，3例健侧颈，与上千直接缝合，腓肠神经移植长度平均为（6．8±1．7）cm；B组健侧颈，神经根分离长度平均为（6．7±0．7）cm，通过短缩伤侧肱骨干和游离提升臂丛神经下干远端，均与臂丛神经下干直接缝合，其中肱骨短缩74例。A组患者中肌力大于M3＋的三角肌占82％，肱二头肌占85％，胸大肌锁骨部占88％。B组患者中肌力大于M3＋的肱二头肌占60％，腕屈肌占72％，指屈肌占63％，拇屈肌占53％。结论健侧颈，神经根经改良的椎体前通路移位修复臂丛神经根胜损伤显著缩短了神经再生的距离，有助于改善臂丛神经根性损伤的疗效。Objective To analyze our experience in the repair of brachial plexus root avulsion injuries with contralateral C7 nerve transfer through a modified prespinal route. Methods Contralateral C7 nerve transfer via the modified prespinal route was performed in 200 patients with braehial plexus avulsion injury. There were 183 male and 17 female patients whose age ranged from 4 to 59 years with an average of （28.3±10.6） year. The interval between injury and surgical intervention was 1 to 11 months, being （3.7±1.6） months on average. The contralateral C7 nerve root was routed underneath the anterior scalene and longus colli muscles, and then passed through the retro-esophageal space to neurotize the recipient nerve. The contralateral C7 was transferred to the upper trtmk and C5 or C6 nerve roots in 60 patients （Group 1） and to the lower trunk in 140 patients （Group 2）. Postoperatively the muscle strength of deltoid, biceps and pectoral major clavicle head was evaluated in group 1, while wrist flexion and finger flexion were assessed in group 2 using the modified British Medical Research Council muscle grading system. Results In group 1, the patients were follow-up for 60 to 143 months, the mean follow-up period being （90±13） months. The mean length of the dissected contralateral C7 nerve root was （6.7±0.8） cm. Direct coaptation with the upper trunk was possible in 3 cases while the rest cases had interposition sural nerve graft with an average length of （6.8±1.7） cm. The muscle strength was graded M3＋ or greater for the biceps muscle in 85% of the patients, for the deltoid muscle in 82% of the patients, and for the upper parts of pectoral major in 88% of the patients. In group 2, the mean follow-up period was （86±15） months. The mean length of the dissected contralateral C7 nerve root was （6.7±0.7） cm. Direct coaptation to the lower trunk was accomplish in all the cases by means of humeral shortening osteotomy and extended dissection and proximal mobilization of the lower trunk

关 键 词：臂丛 神经移位 颈7神经根 

分 类 号：R688[医药卫生—骨科学]