臂丛神经损伤的治疗进展

Advancement of the treatment for brachial plexus injury

臂丛神经损伤是我国常见的上肢严重损伤,其预后较差。目前对于臂丛神经损伤的治疗已成为全球关注的焦点。我们在对臂丛神经损伤诊治近50年的研究中总结了一些治疗方法。神经移位仍是我们首选的手术方案,其中膈神经移位于肌皮神经,副神经移位于肩胛上神经,肋间神经移位于胸背神经与桡神经三头肌肌支,健侧C7神经通过患侧尺神经桥接移位于正中神经已成为治疗全臂丛神经撕脱伤的固定术式。而对于臂丛神经不全损伤的治疗,我们更多地运用丛内移位的方法,例如对于单纯上(中)干根性损伤的患者,我们常利用Oberlin手术来恢复屈肘功能;而对于下干撕脱伤的治疗是目前研究的重点,我们已在临床开展了肱肌肌支移位于前骨间神经以及旋后肌肌支移位于后骨间神经等全新的术式,并获得了较好的疗效。

Brachial plexus injury （BPI） is a severe trauma for the upper limb and its prognosis is always not satisfactory. Our department has depended about 50 years on researching the treatment of BPI and found some feasible and effective procedures. Nerve transfer is the commonly used procedure in our department such as phrenic nerve transfer to musculocutaneous nerve; accessory nerve transfer to suprascapular nerve; intercostal nerve transfer to thoracodorsal nerve and triceps branches; contralateral C7 nerve transfer,and they are all widely used in total brachial plexus avulsion injury. We also use Oberlin procedure to treat upper （middle） trunk injury. Nowadays,the treating of inferior trunk injury becomes the focus,and our department has already performed two new procedures for the treatment of inferior trunk injury which are brachialis branches transfer to anterior interosseus nerve and supinator branches transfer to posterior interosseus nerve,and they both have got satisfactory outcome in clinic.