左右颈7神经交叉移位术后上肢神经再生过程的临床研究  

Clinical study on nerve regeneration of upper limb after C7 nerve cross transfer

作　　者：陈情忠 孙玉成 曹新平 蒋苏 沈云东 冯俊涛 龚炎培 Chen Qingzhong;Sun Yucheng;Cao Xinping;Jiang Su;Shen Yundong;Feng Juntao;Gong Yanpei(Department of Hand Surgery,Affiliated Hospital of Nantong University,Jiangsu 226001,China;Department of Hand Surgery,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]南通大学附属医院手外科,江苏226001 [2]复旦大学附属华山医院手外科,上海200040

出　　处：《中华手外科杂志》2020年第5期337-340,共4页Chinese Journal of Hand Surgery

基　　金：南通市科技项目(MS12018055)。

摘　　要：目的通过经颅磁刺激(transcranial magnetic stimulation,TMS)研究颈7神经交叉移位术后健侧半球与偏瘫肢体神经通路建立的情况,从而阐明该治疗方案的解剖学基础。方法自2016年1月至2016年8月,我们采用健侧颈7神经移位术重建7例偏瘫患者的肢体功能,术后进行随访。分别于术前及术后3、6、12、24个月,通过TMS刺激健侧半球,记录偏瘫肢体肱三头肌、桡侧腕伸肌动作诱发电位的波幅。记录检查结果并进行统计学分析。结果术前及术后3个月刺激健侧大脑半球,偏瘫侧肱三头肌、桡侧腕伸肌均未记录到电生理反应。术后6、12、24个月均记录到偏瘫肢体肱三头肌动作诱发电位;术后12、24个月动作诱发电位的波幅大于术后6个月,差异有统计学意义(P<0.05);术后12、24个月动作诱发电位波幅差异无统计学意义(P>0.05)。术后12、24个月记录到偏瘫肢体桡侧腕伸肌动作诱发电位,波幅差异无统计学意义(P>0.05)。结论健侧颈7神经移位术后12个月,神经生长达到稳定状态,健侧中枢与偏瘫肢体的神经通路形成。Objective To study the establishment of neural pathway between the contralateral hemisphere and hemiplegic limbs after C7 nerve cross transfer using transcranial magnetic stimulation(TMS),so as to clarify the anatomical basis of the treatment.Methods From January 2016 to August 2016,7 patients with hemiplegia were treated by contralateral C7 nerve transfer to reconstruct limb function,and followed up after operation.The amplitude of action evoked potentials of triceps brachii and extensor carpi radialis in hemiplegic limbs were recorded before and 3,6,12 and 24 months after operation by TMS of contralateral hemisphere.The results were recorded and analyzed statistically.Results No electrophysiological response was recorded in the triceps brachii and extensor carpi radialis on the hemiplegic side when the contralateral cerebral hemisphere was stimulated before and 3 months after operation.The amplitude of action evoked potential of triceps brachii in hemiplegic limbs was recorded at 6,12 and 24 months after operation;the amplitude of action evoked potential at 12 and 24 months after operation was greater than that at 6 months after operation,and the difference was statistically significant(P<0.05);there was no significant difference in the amplitude of action evoked potential between 12 and 24 months after operation(P>0.05).At 12 and 24 months after operation,action evoked potential of extensor carpi radialis of hemiplegic limbs was recorded,and the difference was not statistically significant(P>0.05).Conclusion At 12 months after the contralateral C7 nerve transfer,the nerve growth reached a stable state,and the neural pathway between the contralateral center and the hemiplegic limb was formed.

关 键 词：卒中 经颅磁刺激 脑损伤后遗症 偏瘫 颈7神经移位术 

分 类 号：R651.3[医药卫生—外科学]