带与不带血供的全长膈神经移位临床应用比较

CLINICAL COMPARISON OF VASCULARIZED AND NON-VASCULARIZED FULL-LENGTH PHRENIC NERVE TRANSFER

目的比较带与不带血供的全长膈神经移位的临床疗效,并探讨长段神经缺损时,是否应行带血管神经移植。方法1999年8月～2000年3月,对15例臂丛神经损伤患者在电视胸腔镜下行全长膈神经移位肌皮神经吻合术,其中男13例,女2例,均为臂丛神经根性损伤。随机分为A、B及C组,每组5例。A组:保留膈神经起点、游离全长膈神经;B组:保留颈段膈神经、游离胸段膈神经;C组:游离胸段膈神经时带入其伴行血管。膈神经全部移位至肌皮神经。术后行电生理和临床检查,比较肱二头肌功能。结果游离膈神经长度较传统膈神经移位手术增加:A组17.8±1.1cm、B组10.2±1.0cm、C组8.8±0.5cm。A组与B、C组、B组与C组比较,差异有统计学意义(P<0.05)。本组12例获随访28～35个月。3组均在术后5个月左右出现肱二头肌新生电位,6个月左右肱二头肌肌力恢复至3级,疗效比较差异无统计学意义(P>0.05)。结论神经床血供良好的条件下,较细的长段神经进行游离,以及长段神经移位时,带与不带血管疗效无差异。

Objective To investigate the clinical effect of vascularized and non-vascularized full-length phrenic nerve transfer on treating brachial plexus injury. Methods From August 1999 to March 2000, full-length phrenic nerve transfer to musculocutaneous nerve was conducted with the technique of Video Assisted-Thoracic-Surgery in 15 patients （M 13, F 2）that all suffered from avulsion. Three kinds of procedures were carried out. The first was retaining initial point of phrenic nerve and dissecting full length distal nerve （group A）. The second was keeping cervical segment and isolating thoracic segment of phrenic nerve （group B）. The last was vascularized phrenic nerve transfer （group C）. All these phrenic nerves were sutured to musculocutaneous nerves. The results of electrophysiology and function of biceps brachii muscle were compared. Results The length of the dissecting full-length distal nerves in group A, group Band group C compared with that of conventional operation increased by 17.8±1.1 cm, 10.2±1.0 cm and 8.8±0, 5 cm respectively. There was significant difference when group A was compared with group B and group C, when group B was compared with group C, All three procedures had no significant difference and led to the same function recovery of biceps brachii muscle to grade Ⅲ about 6 months later, Conclusion There is no difference in treating effect between vascularized and non-vascularized full length phrenic nerve transfer, when the recipient bed has normal vascularity.