臂丛神经下干、内侧束部损伤133例的远期随访结果

Clinical outcome of brachial plexus lower trunk and medial cord injuries:long-term follow-up of 133 cases

目的观察臂丛神经下干、内侧束损伤患者术后的远期疗效.方法将133例臂丛下干、内侧束损伤患者分成神经断伤修复组40例,作神经端端缝合;神经断伤未修复组61例,未作处理;粘连松解组32例,行神经外松解术.术后随访2～14年,进行屈腕、屈指、分指并指检查及电生理检查.结果断伤未修复组无1例恢复功能.断伤修复组中8例的尺侧屈腕肌及指深屈肌肌力恢复至M3+,但手内在肌功能未恢复.2例臂丛内侧束少部分神经断伤者在缝合神经的同时行神经松解,术后手内在肌肌力恢复至M3+.肌电图示肌肉强收缩时均为单纯-混合相.粘连松解组中75%(24/32)的手内在肌肌力恢复至M3+.结论(1)臂丛神经断裂不能直接修复者应作神经移位术.(2)神经直接修复者有31%恢复部分功能.(3)臂丛神经粘连松解者,有75%可恢复功能.

Objective To evaluate the long-term results of brachial plexus lower trunk or medial cord injuries and determine the surgical indications and options for repair. Methods 133 cases of injury to the lower trunk or medial cord of the brachial plexus were involved in the study. Retrospective analysis of the charts and follow-up survey of the functional recovery of the intrinsic muscles of the hand and the flexor carpi ulnaris （or flexor digitorum profundus）were carried out. There were three major categories of those lower trunk or medial cord injuries involved in the study ：rupture injury with nerve repair for 40 cases, rupture injury without nerve repair for 61 cases, and neurolysis for 32 cases. Wrist flexion, finger flexion, finger adduction and abduction evaluation and electrophysiologic study were done over a period of 2 to 14 years follow-up. Results 61 cases of the rupture injury without nerve repair group showed no functional recovery. Of the 40 cases in the rupture injury with nerve repair group, 31 showed no functional recovery while 8 showed recovery of the flexor carpi ulnaris or flexor digitorum profundus but no functional recovery of the intrinsic muscles of the hand. 2 cases in this group with a small part of neurotmesis in the medial cord underwent neurorrhaphy and ncurolysis and gained M3＋ muscle power of the hand intrinsics. Of the 32 cases of the ncurolysis group, 24 （75%） recovered function of the intrinsic muscles of the hand to M3＋ while 8 showed no functional recovery of the intrinsic muscles of the hand. Conclusion 1. No functional recovery is to be expected if nerve repair is not done in rupture of the lower trunk or medial cord of the brachial plexus. Neurorrhaphy, nerve grafting or nerve transfer should be considered. 2. Even though repair of the rupture of the lower trunk or medial cord is done, no function of the intrinsic muscles of the hand can be restored. Function of the flexor carpi ulnaris and flexor digitorum profundus,however, can be partially recovered. 3. In most cases with non-rupture of the lower trunk or medial cord, the function of the intrinsic muscles of the hand can be recovered after neurolysis.