健侧C7与下干直接吻合治疗创伤性臂丛撕脱伤的中期疗效

The media-term follow-up of contralaterai C7 direct coaptation with lower trunk in patient with brachial plexus root avulsion

目的探讨健侧C7神经根经椎体前通路移位与患侧下干直接吻合治疗创伤性臂丛撕脱伤的中期疗效。方法2004年5月至2009年4月，采用健侧C7与下干直接吻合治疗创伤性臂丛撕脱伤患者220例，其中64例获得3年以上的来院随访，男59例，女5例；年龄7-51岁，平均26岁。伤后到手术时间1-18个月，平均3．7个月。全臂丛撕脱伤60例，中、下干撕脱伴上干不全损伤2例，中、下干撕脱而上干正常2例。健侧C7与下干直接吻合56例，与内侧束直接吻合8例。30例行肱骨短缩截骨，截骨长度2．6-5．8cm，平均3．9cm。结果术后随访36-57个月，平均44个月。41例屈指肌力恢复到4级，3级12例，2级10例，0级1例，优良率为64．1％（41／64）；34例拇长屈肌肌力为4级，3级14例，2级14例，0级2例，优良率为53．1％（34／64）；47例尺侧屈腕肌力为4级，3级9例，2级7例，0级1例，优良率为73．4％（47，64）；32例掌长肌肌力为4级，3级20例，2级11例，0级1例，优良率为50％（32／64）。结论健侧C7与患侧下干直接吻合较传统的手术方法缩短了神经再生的距离及减少了一个吻合口，可显著提高其重建屈指、屈腕功能效果。

Objective To observe the medium-term of funetional recovery of figure and wrist flexion after the direct anastomosis of contralateral C7 transfered through the prespinal route with lower trunk in patient suffered brachial plexus root avulsion. Methods From May 2004 to April 2009, 220 patients with brachial plexus nerve root avulsion were repaired with the direct anastomosis of contralateral C7 transfered through the prespinal route with lower trunk. There were 59 males and 5 females. The patients ranged from 7 to 51 years old, with an average age of 26 years. The interval from injury to operation ranged 1 to 18 months, with a mean of 3.7 months. Among them, 60 cases suffered total brachial plexus avulsion injury, 2 cases were diagnosed with upper trunk partial injury and C2T1 nerve root completely avulsion, 2 eases were diagnosed with C7% nerve root completely avulsion and with normal upper trunk. Contralateral C7 nerve root direct coapted with lower trunk in 56 cases and with media cord in 8 cases. In order to reduce the tension at the anastomosis site, humeral shorten osteotomy were performed in 30 cases, the length of the shorten bone zanged 2.6-5.8 cm, with the average of 3.9 cm. Results The following up period was 36 to 57 months, with the average 44 months. According to the standard of medical research council of the United Kingdom, the rate of musele strength of finger, thumb wrist flexor and eubitalis grailis attained grade 4 were 64.1% （41/ 64）, 53.1% （34/64）, 73.4% （47/64） and 50% （32/64） respectively. Conclusion The direct anastomosisstandard of contralateral C7 with lower trunk in patient with brachial plexus injury can remarkably improve the effect of reconstructing the function of finger and wrist flexion because it reduces one anastomosis site and decreases the distance of nerve regeneration compared with the traditional method.