摘要
目的应用电生理技术研究肱肌肌支的神经根来源及探索肱肌肌支移位术的可行性和有效性.方法选择10名臂丛损伤作健侧C7移位术的患者,术中暴露正常的臂丛神经,用Reporter四道程肌电诱发电位仪,刺激C5~T1神经根,在肱肌记录诱发电位并计算其潜伏期及波幅.对1例肩外展、屈肘功能正常而手部无功能的C7脊髓损伤患者,在右侧上肢行肌皮神经肱肌肌支移位术,术中将肱肌肌支移至骨间前神经,以恢复手指屈曲功能.结果10名行健侧C7移位者术中刺激C5~C7均记录到复合肌肉动作电位(compound muscle action potential,CMAP),而刺激C8T1则无CMAP出现.C5~7CMAP的潜伏期为[(6.32±1.50)ms,±s,下同]、(6.51±1.36)ms和(6.99±1.33)ms,波幅为(2.81±3.17)Mv、(3.01±3.20)Mv和(1.55±1.99)Mv.其中以C6的波幅最大,提示C6支配肱肌的纤维数可能最多,但经统计学处理,各神经根间的差异无统计学意义(P>0.05).1例患者术后第2天检查屈肘功能正常,电生理检测肱二头肌为单纯相.术后1年半随访,术侧拇示指出现屈曲动作.结论肱肌同时接受来自C5~7神经纤维的支配,该肌支移位至C8T1为主支配的正中神经是可行及有效的.
Objective To trace the origination of brachialis muscle branch at the root level by means of intraoperative electrophysiological study and discuss the rationale of transfer of brachialis muscle branch of them usculocutaneous nerve to the median nerve. Methods EMG was done in 10 cases of contralateral C7 nerve root transfer. After exploration of the normal brachial plexus, the C5 - T1 nerve roots were stimulated to record compound muscle action potential (CMAP) of the brachialis muscle. Amplitude and latenct period of CMAP were calculated.Brachialis muscle branch transfer was carried out in one case of C7 level spinal cord injury. Pre-operative examination showed normal shoulder abduction and elbow flexion and absence of finger flexion. Brachialis muscle branch of the musculocutaneous nerve was transferred to the anterior interosseous nerve of the median nerve. Results CMAP was recorded in the brachialis muscle when C5 - C7 nerve roots of the normal brachial plexus were stimulated. Average latent period of CMAP were 6.32 ± 1.50ms, 6.51 ± 1.36ms, and 6.99±1.33 ms respectively. Average amplitude of CMAP were 2.81 ± 3.17mV, 3.01 ± 3.20mV, and 1.55 ± 1.99mV respectively. No CMAP was elicited when C8 or T1 was stimulated. Among these, the highest CMAP amplitude was recorded when C6 was stimulated indicating that nerve fibers innervating the brachialis muscle were mainly originated from C6 nerve root although there was no statistically significant difference among the C5-7 roots. One and half year follow-up of the nerve transfer case revealed recovery of thumb and index finger flexion. Conclusion The nerve fibers innervating the brachialis muscle originate from C5 - C7 nerve roots. When it is transferred to the median nerve which mainly originates from C8 - T1, the results should be reliable.
出处
《中华手外科杂志》
CSCD
北大核心
2005年第4期197-199,共3页
Chinese Journal of Hand Surgery
基金
上海市科委基金资助项目(034119805)