膈神经牵拉伤12例

Phrenic Nerve Traction Injury: An Analysis of 12 Cases

目的：研究膈神经牵拉伤的临床特征及肺功能变化．方法：分析１２例膈神经牵拉伤患者的病因，行肺功能、电生理学、病理学检测．结果：１２例膈神经牵拉伤中，８例为完全性损伤（６６．７％），４例为部分损伤（３３．３％）．完全性损伤均为摩托车车祸致伤，其昏迷、骨折史分别为８７．５％、７５．０％，而部分损伤可为车祸或跌伤所致，其昏迷、骨折史分别为５０．０％、０．０％．肺功能测定各指标中，仅伤后３个月内肺活量（ＶＣ）和残气占肺总量百分比（ＲＶ／ＴＬＣ）轻度下降，而最大通气量（ＭＶＶ）、时间肺活量（ＦＥＶ１，ＦＥＶ２，ＦＥＶ３）均正常．结论：膈神经牵拉伤常为头颈极度分离牵拉所致，以完全损伤为多见；单侧膈神经牵拉伤后肺功能仅早期ＶＣ出现轻度改变，对呼吸功能无特殊影响；认识膈神经牵拉伤对提供高质量移位动力神经、提高膈神经移位术疗效有重要意义．

Aim: To investigate the clinical characteristics of phrenic nerve traction injury and related changes of pulmonary function. Methods: Twelve cases of phrenic nerve traction injury were analyzed. Electrophysiological examination, pulmonary function test and pathological observation were performed. Results: Among the 12 cases, 8 was complete injury (66.7%), 4 partial injury (33.3%). All the complete injuries were caused by motor traffic accidents, which were associated with more coma and fractures, about 87.5% and 75.0% respectively, however, the incidence of coma and fracture in partial injury declined to 50.0% and 0.0% respectively. Pulmonary function studies revealed that only vital capacity (VC) and residue volume/total lung capacity (RV/TLC) of the predicted volume slightly declined within 3 months after injury. Conclusion: Phrenic nerve traction injury is frequently caused by extreme separation of the head and neck with complete injury being the majority. Unilateral phrenic nerve traction injury has little influence on palmonary function except for a slight change of VC. The study of the injury attaches much importance to the improvement of the therapeutic effects of phrenic nerve transposition