尺神经部分神经束移接肱二头肌运动支术中肌电和疗效观察

Nerve transfer to biceps brachialis using a part of ulnar nerve for treatment of upper trunk avulsion of brachial plexus: Intraoperative electrophysiological monitoring and clinical observation

目的研究利用尺神经部分神经束移位，治疗臂丛上干根性撕脱伤的临床效果，以及术中应用诱发电位检测供区神经束的经验。方法１９９６年７月～１２月，对６例臂丛上干根性撕脱伤行部分尺神经神经束移接于肌皮神经外侧支手术。术中对尺神经保留部分和切取部分的神经束进行电生理检测。结果尺神经保留部分和切取部分神经束诱发电位的潜伏期和波幅，两者结果均无明显差异。４例术后随访３～７．５个月，肱二头肌肌力恢复到２～３级，供区神经支配区无功能障碍。肌电图检查：神经束移位后的肱二头肌均有新生电位出现。结论采用部分尺神经束移位，治疗臂丛上干根性撕脱伤以恢复屈肘功能。

Objective To treat upper trunk avulsion of brachial plexus by neurotization using a part of ulnar nerve. The clinical outcome and the role of intraoperative EMG monitoring was discussed. Methods 6 cases treated from July to December, 1996 were invovled. A part of the fascicles of the ulnar nerve was transfered to coapt with the lateral part of the musculocutaneous nerve. Intraoperative electrophysiological examination was carried out of the resected part and the spared part of the ulnar nerve. Results No significant difference was found in the latent period and amplitude of the evoked potentials of the spared fascicles and resected fascicles of the ulnar nerve. 4 cases were followed up for 3 to 7.5 months postoperatively. Muscle power of biceps brachialis recovered to MRC 2～3. EMG of biceps brachialis showed nascent potentials. The functions innervated by the ulnar nerve were not affected. Conclusion Neurotization using a part of ulnar nerve is a practicable procedure for restoration of elbow flexion in upper trunk avulsion of brachial plexus.