全长膈神经移位重建屈指功能的临床报告

Full length phrenlc nerve transfer for restoration of finger flexion： a clinical report

目的探讨在胸腔镜视下切取全长膈神经直接移位至正中神经内侧头重建全臂丛撕脱伤后屈指功能的可行性，为全臂丛根性撕脱伤后屈指功能的恢复提供新思路。方法对3例全臂丛根性撕脱伤的患者，采用胸腔镜视下游离胸腔内的全长膈神经，于入膈肌处切断膈神经，将全长膈神经直接移位于正中神经内侧头，术后每3个月随访肺功能和临床功能恢复情况。结果3例患者随访时间均超过3年，拇长屈肌及2—5指指浅屈肌肌力均恢复至3—4级，掌长肌肌力2例为2级，1例为1级；桡侧腕屈肌、旋前圆肌、鱼际肌肌力为0级。肺功能显示患者在术后6个月内有不同程度的肺功能降低，但在1年内都恢复到术前水平。结论胸腔镜视下切取全长膈神经直接移位至正中神经内侧头重建全臂丛撕脱伤后的屈指功能是一种可行的新术式。

Objective To evaluate the effect of VATS full length phrenic nerve transfer to medial head of the median nerve for finger flexion restoration in brachial plexus total avulsion injuries. Methods Three patients with brachial plexus total avulsions were treated. The phrenic nerve was mobilized to its full length in the thoracic cavity and harvested thoracoscopically, It was then transferred to the medial head of the median nerve. Postoperatively the patients were followed every 3 months for evaluation of pulmonary function and clinical examination. Results All 3 patients were followed for over 3 years. Muscle power of flexor pollicis longus and flexor digitorum superficialis was 3° to 4°. Palmaris longus strength was 2° in 2 cases and 1° in 1 case. There was no recovery of flexor carpi radialis, pronator teres and thenar muscle. Pulmonary function was reduced within the first 6 months after the surgery but returned to preoperative level after 1 year. Conclusion Thoracoscopic harvesting of phrenic nerve and transfer full length phrenic nerve to the medial head of the median nerve is a safe and useful choice to restore finger flexion in brachial plexus injury patients.