正中神经束支移位重建屈肘功能

Median Nerve Partial Transfer for Restoration of Elbow Flexion

目的探讨正中神经束支移位重建屈肘功能的临床疗效,观察供体神经的变化。方法在臂丛神经上干损伤屈肘功能障碍时,应用正中神经部分束支移位与肌皮神经肱二头肌支吻合重建屈肘功能14例,并进行10～36个月的随访。根据肱二头肌肌力和肘关节活动范围评定术后疗效。结果本组优9例,可3例,差2例。影响手术疗效的因素有年龄、损伤距手术时间、臂丛神经损伤的程度、神经吻合的质量,以及功能锻炼的方式方法。手术前后供体神经功能没有明显变化。结论正中神经部分束支移位重建屈肘功能是治疗臂丛神经上干损伤的一种简便、安全、疗效可靠的治疗方法。

Objective To investigate the clinical effect of median nerve partial fascicle transfer for restoration of elbow flexion, and observe the change of donor nerve. Methods Fourteen patients with elbow flexion dysfunction secondary to brachial plexus injury underwent nerve transfer using a part of median nerve to the motor branch of the biceps muscles to restore the elbow flexion. Follow- up period ranged from 10 to 36 months. Results According to the biceps strength and active rang of elbow joint, the patients could be divided into 3 grades： good in 9 patients with biceps strength M4 and elbow flexion of more than 90 degree, moderate in 3 patients with biceps strength M3 and elbow flexion between 60 and 90 degree and poor in 2 patients with biceps strength M0 - M2 and elbow flexion of less than 60 degree. The age of patients, the post traumatic interval, the degree of brachial plexus injury, the quality of nerve＇s inosculation, and the method of functioning exercise were the factors influencing the treatment effectiveness. The donor nerve had no obvious change before and after the operation. Conclusion Median nerve partial transfer for restoration of elbow flexion is a simple, safe and effective way to treat brachial plexus injury.