成人臂丛根性损伤临床分型的初步研究

Preliminary research on the clinical classification of the brachial plexus root injury in adult

目的探讨成人臂丛根性损伤的临床分型。方法回顾性研究中山大学附属第一医院近5年来收治并手术探查证实、资料完整的成人臂丛根性损伤病例，分析、归纳出成人臂丛根性损伤临床分型。结果总结155例臂丛根性损伤病例，结合术前临床诊断与影像学诊断、术中探查与电生理学检测、术后随访研证，初步归纳出成人臂丛根性损伤临床分型，在上臂丛损伤（A型）、下臂丛损伤（B型）、全臂丛损伤（C型）三大类基础上，可进一步细分为七小类：①上臂丛损伤AI型：C5、6根完全性损伤（撕脱或断裂），伴或不伴膈神经损伤；②AⅡ型：C5-7根完全性损伤；③AⅢ型：C5-7根完全性损伤伴C8、T1不全性损伤；④下臂丛损伤BI型：C8、T1（或伴C7）完全性损伤；⑤BⅡ型：T1、C7、8完全性损伤伴C5、6不全损伤；⑥全臂丛损伤CI型C5～T1根性撕脱伤；⑦CⅡ型：T1、C7、8根性撕脱伤伴C5、6根断裂。结论成人臂丛根性损伤可分为三大类七小类，但臂丛根性损伤临床分型的分布不平均．以上臂丛损伤（A型）（55．5％）和全臂丛损伤（c型）（40．6％）最为常见，下臂丛损伤（C型）最少（3．9％）。上臂丛损伤A型中，AIII型最多（61．6％），AII型次之（31．4％），AI型最少（7％）。

Objective To explore the clinical classification of the braehial plexus root injury in adult. Methods All 155 cases of adult brachial plexus root injury in the First Affiliated Hospital of Sun Yat-sen University, were collected and analyzed on their characteristic,operative methods, and clinical outcome so as to find the distribution and incidence of different type of brachial plexus root injury and set up the clinical classification of adult brachial plexus root injury. Results Braehial plexus root injuries in adult could be classified into three types and seven subtypes. Type A is upper brachial plexus root injury, including type AI （C5, C6 completely avulsion or rupture injury , with/without phrenic nerve injury）, type AII （C5- C7 completely injury）, and type AIII （C5-C7 completely injury accompanied with C8,T1 incompletely injury）. Type B is lower brachial plexus root injury, including type BI [ C8, T1 （with/without C7） completely injury ] and type BII （C8,T1,C7 completely injury, accompanied with C5.6 incompletely injury）. Type C is total braehial plexus root injury, including type CI（C5-T1 completely root avulsion） and type CII（C7-T1 root avulsion accompanied with C5,6 root or trunk rupture ）. For the cases of every type, upper braehial plexus root injury type A have 86 cases, in which type AI 6 cases, type AII 27 cases and type AIII 53 cases; lower braehial plexus root injury type B have 6 cases, in which type BI 2 cases and type BII 4 cases; total braehial plexus root injury type C have 63 cases, in which type CI 51 cases and type CII 12 cases. Conclusion Except the upper, lower, and total three types, brachial plexus root injuries in adult could be classified further into seven subtypes. The distribution of different type of adult brachial plexus root injury is overbalance：upper lype A （55.5%） is more often seen, total type C（40.6%） followed and lower type B（3.9%） is the least seen. In upper brachial plexus root injury, type AIII（61.6%） is more often seen, type AII（31.4%） followed and type AI（7%） is less seen.