健侧C_7神经根移位治疗臂丛神经根性撕脱伤的疗效观察

CLINICAL OUTCOME OF CONTRALATERAL C_7 NERVE ROOT TRANSPOSITION FOR TREATMENT OF BRACHIAL PLEXUS ROOT AVULSIOH INJURY

目的观察健侧C7神经根移位修复臂丛神经根性撕脱伤术后患侧肢体运动、感觉功能恢复情况,以及该术式对健侧肢体的影响。方法 2008年8月-2010年11月,采用健侧C7神经根移位修复全臂丛神经根性撕脱伤22例。患者均为男性;年龄14～47岁,平均33.3岁。术前临床检查及电生理检测均确诊为全臂丛神经根性撕脱伤。其中修复正中神经16例,桡神经3例,肌皮神经3例;一期手术2例,二期手术20例。观察手术前、后患侧肢体运动、感觉功能恢复情况。结果 21例患者获随访,随访时间7～25个月,平均18.4个月。健侧C7神经根修复正中神经:屈腕肌肌力达3级或以上10例,屈指肌肌力达3级或以上7例;感觉恢复达S3或以上11例。健侧C7神经根修复肌皮神经:屈肘肌肌力达3级或以上2例;前臂外侧皮肤感觉达3级2例。健侧C7神经根修复桡神经(失访1例)伸腕肌肌力达3级1例;感觉恢复达S3 1例。结论健侧C7神经根全干移位修复全臂丛神经根性撕脱伤效果较好,分期手术是提高疗效的重要因素。

Objective To observe the recovery of the sensory and motor function of the repaired limb and the impact on the healthy limb function after contralateral C7 nerve root transposition for treating brachial plexus root avulsion injury.Methods Between August 2008 and November 2010,22 patients with brachial plexus root avulsion injuries were treated with contralateral C7 nerve root transposition.All patients were male,aged 14 to 47 years（mean,33.3 years）.Total brachial plexus root avulsion was confirmed by preoperative clinical examination and electrophysiological tests.In 22 cases,median nerve was repaired in 16 cases,radial nerve in 3 cases,and musculocutaneous nerve in 3 cases;primary operation was performed in 2 patients,and two-stage operation was performed in 20 patients.The sensory and motor functional recovery of the repaired limb was observed after operation.Results Twenty-one patients were followed up 7-25 months（mean,18.4 months）.In 16 cases of contralateral C7 nerve root transposition to the median nerve,wrist flexors reached more than M3 in 10 cases,while finger flexors reached more than M3 in 7 cases;sensation reached more than S3 in 11 cases.In 3 cases of contralateral C7 nerve root transposition to the musculocutaneous nerve,elbow flexors reached more than M3 in 2 cases;sensation reached more than S3 in 2 cases.In 3 cases of contralateral C7 nerve root transposition to the radial nerve,wrist extensor reached more than M3 in 1 case;sensation reached more than S3 in 1 case.Conclusion Contralateral C7 nerve root transposition is a good procedure for the treatment of brachial plexus root avulsion injury.Staged operation is one of important factors influencing treatment outcome.