神经移位术修复臂丛神经根性撕脱伤

Repairing brachial plexus root avulsion by nerve transfer

目的:总结臂丛神经根性撕脱伤的治疗经验,讨论不同类型的臂丛神经根性撕脱伤患者的治疗方法。方法:回顾1998年12月至2002年9月间通过神经移位法修复臂丛神经根性撕脱伤患者18例,针对不同类型的臂丛神经根性损伤采用不同的手术方案;术后随访2年2个月至5年8个月,平均随访时间为3年10个月。结果:18例患者均得到2年以上临床随访,肩外展功能丧失的16例患者中,冈上肌肌力恢复3级以上者11例,三角肌肌力恢复3级以上者4例,主动肩外展60度以上者12例;屈肘功能丧失16例患者中,肱二头肌肌力恢复3级以上者14例;屈指、屈腕功能丧失患者6例中,屈指、屈腕肌力恢复3级以上者2例;伸肘、伸腕、伸指功能丧失患者4例中,伸腕肌力恢复3级以上者4例,伸肘肌力恢复3级以上者3例,伸指肌力恢复3级以上者3例。结论:神经移位术修复臂丛神经根性撕脱伤,手术前准确的诊断、早期手术、精细操作是功能恢复的关键;应根据不同的损伤类型选择不同的手术方式;对年轻患者应尽可能修复所有损伤神经。

Objective： To summarize the experience of surgical treatment of brachial plexus root avulsion and to discuss the operations for different of types brachial plexus root avulsion. Methods： We enrolled 18 cases of brachial plexus root avulsion with different surgical treatment by nerve transfer from October, 1998 to September, 2002. The follow-up time between 2 years 2 months to 5 years 8 months, the mean time being 3 years 10 months. Results： The 18 patients were followed up more than 2 years. Of the 16 patients who lost shoulder abduction 11 had recovered to more than grade 3 strength of supraspinatus muscle; 4 had recovered to more than grade 3 strength of deltoid muscle. Of the 16 patients who lost elbow flexor function 14 had recovered to more than grade 3 strength of biceps muscle. Of the 6 patients who lost wrist and finger flexion, 2 had recovered to more than grade 3 strength in flexion of wrist and fingers. Of the 4 patients who lost radial nerve function, 3 had recovered to more than grade 3 strength of extend elbow and finger. All of them had recovered grade 3 strength of extend wrist. Conclusion： Accurate diagnosis, early operation and refine manipulation are key factors for functional recovery in transferring nerve treatment for brachial plexus root avulsion. Different methods should be selectedaccording to the types of brachial plexus avulsion. All injured nerves should be repaired for young patients.