臂丛神经上干损伤的屈肘功能重建体会

Reconstruction of elbow flexion after C5,C6 brachial plexus avulsion injuries

目的:探讨臂丛神经上干根性撕脱伤后重建屈肘功能的方法。方法:对7例臂丛上干根性撕脱伤,术前EMG、MRI及全面的理学检查确诊后,或者通过术中神经探查及术中肌电检测确诊后,施行新的神经移位术:尺神经部分神经束移位至肌皮神经的肱二头肌肌支(经典的Oberlin手术),正中神经部分神经束移位至肌皮神经的肱肌肌支,施行双重移位,重建屈肘功能。术中运用电生理技术,增加手术的准确性和合理性,术后早期行理疗、功能锻炼及神经营养药物等综合措施。结果:经过术后6～28个月的随访,屈肘功能恢复满意。5例随访超过1年的患者,目标肌力均达M3以上,随访少于8个月的2例患者,目标肌力也达M1～2。结论:对臂丛上干根性撕脱伤确诊后,尺神经及正中神经部分神经束双重移位是重建屈肘功能有效的、合理的治疗方法,较之单一的尺神经部分束移位(即为传统的Oberlin术式),增加了屈肘功能的恢复效率。

Objective：To investigate methods of reconstructing elbow flexion after the C5,C6 nerve avulsion in brachial plexus injuries.Methods：Seven patients were confirmed as complete C5,C6 nerve avulsion by electromyogram（EMG）,magnatic resonance imaging（MRI）or physical examination before operation or by surgical exploration.Further nerve transposition was then applied to reconstruct the elbow flexion,in which motor fascicle from the ulnar nerve was transferred to the biceps branch of the musculocutaneous nerve（Oberlin transfer）,partial branch of the median nerve to the brachialis branch.During this procedure,electrophysiological technique was used to improve accuracy and feasibility.Postoperative comprehensive measures,such as physical therapy,active functional training and nerve-nutrition drugs etc.were carried out.Results：Follow up ranged from 6-28 months（14 months on average）showed all patients obtained satisfied elbow flexion.The muscle power recovery in 5 cases with a follow-up period exceeding 1 year achieved as M3,2 cases with follow-up less than 8 months also achieved recovery of M1-2.Conclusions：With better recovery of muscle power,double nerve transfer is an effective method for the reconstruction of elbow flexion in patients that are confirmed as C5,C6 root never avulsion in brachial plexus injuries.