改良健侧颈_(7)神经根移位术治疗全臂丛神经根性撕脱伤  

Modified contralateral C_(7) nerve root transfer for the treatment of total brachial plexus root avulsion injury

作　　者：王立[1] 段文旭[1] 王丰羽 张晓然[1] 马学林 邵新中[1] 张哲敏[1] Wang Li;Duan Wenxu;Wang Fengyu;Zhang Xiaoran;Ma Xuelin;Shao Xinzhong;Zhang Zhemin(Department of Hand Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院手外科,石家庄050051

出　　处：《中华手外科杂志》2022年第5期368-370,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨采用改良健侧颈_(7)移位术治疗伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤的临床疗效。方法自2017年10月至2019年10月,我院对16例伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤患者,行改良健侧颈7移位术。手术分两期进行:Ⅰ期,将健侧颈_(7)前股外侧束经游离桡神经浅支移植修复患侧上干前股;将健侧颈_(7)后股的一束纤维,经尺神经手背支游离移植修复患侧肩胛上神经;健侧颈_(7)后股大部与带血供的患侧尺神经远端缝合。Ⅱ期:患侧尺神经远端移位正中神经远端。结果 16例患者随访20~45个月,平均32个月。依据顾玉东臂丛神经损伤修复后功能评定标准:冈上、下肌肌力恢复达M3及以上8例,M_(2) 6例,M_(0)~M_(2) 2例。肱二头肌肌力M_(3)及以上11例,M_(2) 5例。屈腕、屈指肌力M3及以上9例,M2~M1 7例。正中神经支配区皮肤感觉恢复达S3 6例,S2~S1 10例。结论对伴有膈神经、副神经损伤的全臂丛根性撕脱伤患者行改良健侧颈7移位术,可以充分发挥健侧颈_(7)的动力储备,取得满意的临床疗效。Objective To investigate the clinical efficacy of modified contralateral C_(7) transfer in the treatment of total brachial plexus root avulsion injury with phrenic nerve and accessory nerve injury.Methods From October 2017 to October 2019,16 patients with total brachial plexus root avulsion injury with phrenic nerve and accessory nerve injury were treated with modified contralateral C_(7) transfer in our hospital.The operation was carried out in two stages:stageⅠ,the lateral bundle of anterior thigh of contralateral C_(7) was transplanted to repair the anterior thigh of the upper trunk on the affected side through the free superficial branch of radial nerve.The suprascapular nerve of the affected side was repaired by free transplantation of a bundle of fibers from the posterior thigh of contralateral C_(7) through the dorsal branch of ulnar nerve.Most of the posterior thigh of contralateral C_(7) was sutured to the distal end of the ulnar nerve with blood supply.StageⅡ,the distal ulnar nerve of the affected side was transferred to the distal median nerve.Results All the 16 patients were follow-up for 20 to 45 months,with an average of 32 months.According to Gu Yudong′s functional evaluation criteria after repair of brachial plexus injury,the strength of supraspinatus muscle and infraspinatus muscle recovered to M_(3) and above in 8 cases,M_(2) in 6 cases,and M_(0) to M_(2) in 2 cases.The strength of biceps brachii muscle recovered to M_(3) and above in 11 cases,M2 in 5 cases.The strength of wrist and finger flexion recovered to M3 and above in 9 cases,M_(2) to M_(1) in 7 cases.The skin sensory recovery in the median innervated area reached S3 in 6 cases and S2 to S1 in 10 cases.Conclusion The modified contralateral C_(7) transfer in patients with total brachial plexus root avulsion injury accompanied by phrenic nerve and accessory nerve injury can give full play to the dynamic reserve of contralateral C_(7) and achieve satisfactory clinical efficacy.

关 键 词：臂丛 神经移位 健侧颈_(7)神经根 膈神经 副神经 

分 类 号：R688[医药卫生—骨科学]