全长膈神经移位恢复伸腕指功能的实验研究

Experimental study of full length phrenic nerve transfer for restoration of wrist and finger extension

目的 比较全长膈神经移位至上臂段桡神经前臂支不同部分恢复伸腕、指功能的效果。方法 取SD大鼠30只，随机分为3组，每组10只。内侧组：开胸切取全长膈神经移位至背阔肌止点下缘处桡神经前臂支内侧部分。外侧组：开胸切取全长膈神经移位至背阔肌止点下缘处桡神经前臂支外侧部分。直接组：将桡神经前臂支于背阔肌止点下缘处切断再原位缝合，此组作为对照组。于术后4个月行大体观察、电生理和肌湿重检测。结果 内侧组和外侧组大鼠均于术后19至．23d出现与呼吸同步的伸腕、指动作。电生理和肌湿重检测显示，内侧组腕伸肌（尺侧腕伸肌）恢复优于外侧组，差异有统计学意义（P〈0．05），伸指肌恢复两组相似，差异无统计学意义（P〉0．05）。结论 经胸切取全长膈神经移位至上臂段桡神经内侧部分能更全面的恢复伸腕、指功能。

Objective To evaluate the effect of full length phrenie nerve transfer to different portion of the radial nerve for restoration of wrist and linger extension. Methods Thirty Spragne-Dawley rots were randomly divided into 3 groups： medial group, lateral group, and direct eoaptation group, with 10 each. In the medial group full length phrenie nerve was harvested through open chest surgery and transferred to the medial portion of radial nerve at the level of latissimus dorsi insertion. Full length phrenie nerve was transferred to the lateral portion of radial nerve at the level of latissimus dorsi insertion in the lateral group. In the direct eoaptafion group the radial nerve was cut at that level and sutured directly. Gross observation, electrophysiolngieal testing and muscle weight examination were performed 4 months after the operation. Results Extension of wrist and fingers in both medial and lateral groups appeared at the same pace of respiration at postoperative day 19 to 23. Extensor carpi ulnaris recovered better in the medial group than in the lateral group, while there was no difference in the recovery of extensor digitorum communis. Conclusion The treatment outceme of transferring full length phrenie nerve to the medial portion of the radial nerve is superior in restoring wrist and finger extension.