二期多组神经移位治疗臂丛神经根性撕脱伤的临床应用和疗效

CLINICAL APPLICATION AND EFFICIENCY OF TWO STAGE MULTIPLE NERVES TRANSFER FOR TREATMENT OF ROOT AVULSION OF BRACHIAL PLEXUS

目的分析治疗臂丛神经根性撕脱伤的二期手术方法及其效果。方法2001年8月～2003年4月8例全臂丛神经根性撕脱伤患者,年龄18～38岁。平均伤后6个月内,均应用以下术式治疗。手术步骤:一期手术,膈神经移位至臂丛上干前股,副神经移位至肩胛上神经;健侧C7神经移位至患侧尺神经;二期手术,第4、5、6、7肋间神经移位至桡神经和胸背神经,健侧C7神经经尺神经移位至正中神经。结果术后8例均获随访,时间为二期术后13～25个月,平均21个月。所有患者均有不同程度恢复,相应靶肌肉肌力恢复大于或等于M3为有效恢复,肌皮神经有效恢复6例,恢复率为75.0%;肩胛上神经有效恢复3例,恢复率为37.5%;桡神经有效恢复3例,恢复率为37.5%;胸背神经有效恢复6例,恢复率为75.0%;正中神经有效恢复5例,恢复率为62.5%。感觉恢复情况:正中神经感觉4例为S3,3例为S2,1例为S1。结论二期多组神经移位安全有效,对部分早期臂丛神经损伤并要求缩短手术次数的患者,是一种可选择的方法。

Objective To investigate the results of two stage multiple nerves transfer for treatment of complete brachial plexus root avulsion. Methods Eight patients with complete brachial plexus avulsion, aging 18-38 years and with a mean 6 months interval of injury and repair, were surgically treated with the following procedures. One stage surgical procedure was that the contralateral C_7 never root was transferred to the ulnar nerve, the phrenic nerve to the anterior division of upper trunci plexus brachialis and the accessory nerve to the suprascapular nerve. Two stage surgical procedure was that the ulnar nerve was transferred to the median nerve , the intercostal nerves to the radial nerve and the thoracodorsal nerve. Results All patients were followed up from 13 months to 25 months((21) months on average), muscle reinnervation was observed in all patients. Return of muscle power of M_3 or better are regarded as effective. The effective recovery results were 75% in musculocutaneous nerve, 37.5% in suprascapular nerve, 37.5% in radial nerve, 75% in thoracodorsal nerve and 62.5% in median nerve. In sensory recovery of the median nerve, 4 patients obtained S_3, 3 patients S_2 and 1 patient S_1. Conclusion Two stage multiple nerves transfer for treatment of root avulsion of brachial plexus can achieve better motor function results and is safe and effective. The procedure should be recommended for treatment of root avulsion of brachial plexus in selected patients with complete brachial plexus root avulsion, especially in young patients with a short interval between injury and repair. It is one of the alternative options.