膈神经损伤与臂丛上干节前损伤的关系

THE RELATIONSHIP BETWEEN LESION OF PHRENIC NERVE AND PREGANGLION INJURY OF UPPER TRUNK OF BRACHIAL PLEXUS

目的：了解膈神经损伤与臂丛神经上干节前损伤的关系。方法：应用Ｘ线、电生理技术及术中观察和电刺激等方法回顾性评价４２例臂丛神经损伤合并膈神经损伤患者的膈神经功能状态。结果：４２例中２６例Ｘ线表现为膈肌抬高及活动度下降，术中观察膈神经瘢痕化、质地变硬，电刺激无膈肌反应；１４例Ｘ线无异常，其中１０例术中观察同前，４例见膈神经正常或粘连，电刺激有反应但反应稍差；２例未获资料。电生理检查膈神经有损伤的１２例中，８例为完全损伤，相应Ｘ线有膈肌抬高，电刺激无膈肌反应，４例为部分损伤，Ｘ线无异常，电刺激见膈肌有反应但反应稍差。所有病例均经手术证实有上干节前损伤。结论：膈神经损伤时提示臂丛上干损伤的部位在节前。

Objective:To survey the relationship between lesion of phrenic nerve and preganglion injury of upper trunk of brachial plexus.Methods:The phrenic nerve function in 42 cases of brachial plexus injury associated with phrenic nerve lesion was retrograted.Evaluated by X-ray,electrophysiology,observation in operation.Result:It was showed that diaphragm lift in 26 of 42 cases in X-ray,no change in 14,two lost of material.There was no reaction when phrenic nerve was stimulated in 10 of 14 cases with no change in X-ray,some reaction in other 4 cases.12 cases of phrenic nerve lesion were observed by electrophysiologic examination.Eight of 12 cases were complete phrenic nerve lesion in which lift of diaphragm was showed in X-ray and no reaction was observed when stimulatied.Four of 12 cases were partial phrenic nerve lesion in which X-ray showed no changed and there was reaction when it was stimulated.The lesion of upper trunk was comfirmed at preganglion in all the patients by operation.Conclusion:The article demonstrated that the lesion of phrenic nerve indicates preganglion injury exists in upper trunk of brachial plexus.