膈神经移位治疗臂丛损伤的临床应用和早期疗效

Clinical application and early outcome of transfer of phrenic nerve in treatment of brachial plexus avulsion injuries

目的探讨膈神经移位至肌皮神经重建屈肘功能的临床应用及早期疗效。方法对8例臂丛根性撕脱伤行膈神经移位术,膈神经与上干前股的肌皮神经束直接吻合5例,膈神经通过神经移植桥接至肌皮神经3例,术后随访评定其屈肘功能。结果8例经10月～2年随访,肱二头肌肌力在2级以上5例,有效率62.5%。结论膈神经移位术是治疗臂丛根性撕脱伤的理想术式,重视术前和术中膈神经功能的评估、神经移位时吻合方法的合理选择和术后综合康复锻炼是提高手术疗效关键。

Objective To investigate clinical application of phrenic nerve transfer for restoration of elbow flexion in treatment of brachial plexus avulsion injueries and to analyze its early treatment outcome.Methods Transfer of phrenic nerve was done for treatment of brachial nerve root avulsion injuries in 8 cases.Direct anastomosis was carried out in 5 cases between phrenic nerve and anterior division of upper trunk in brachial plexus.Nerve anastomosis was done in 3 cases through nerve transfer between phrenic nerve and muslocutaneous nerve. The function of elbow flexion was assessed through the postoperative foUow-up.Results According to 10 months to 2 years follow-up in 8 cases, the muscle tone in biceps brachial muscles obtained 2 grades and above in 5 cases,with 62.5% in effective rate.Conclusion Phrenic nerve transfer was an ideal procedure for treatment of brachial plexus root avulsion injuries. The key point of improvement of treatment outcome was the assessment of phrenic nerve function between preoperative and postoperative period,of rational selection of anastomic methods in nerve transfer,and of comprehensive postoperative rehabilitation.