肋间神经移位治疗全臂丛根性撕脱伤两种术式的比较

Comparison of two procedures of intercostal nerve transfer for treatment of total brachial plexus root avulsion

目的 比较肋间神经移位直接与肌皮神经缝合 ,和通过皮神经移植桥接肌皮、肋间神经两种术式的疗效。方法 3 2例全臂丛根性撕脱伤 ,其中将肋间神经游离 10～ 13cm ,经电刺激证实含有运动神经束后切断 ,与肌皮神经直接缝合 2 0例。在肋间神经与肌皮神经间移植皮神经 (平均长 10 .2cm) 12例。术后平均随访 3年 ,观察肱二头肌屈肘功能及肌力的恢复。结果 肌力达 3级或 3级以上的 ,神经移位组占 75 % ,神经移植组为 2 5 %。结论 肋间神经与肌皮神经缝接后 ,屈肘功能恢复明显 ,直接缝合组优于神经移植桥接组 (P <0 .0 1)。

Objective To compare the treatment outcome of intercostal nerve transfer to the musculocutaneous nerve by direct suture or via cutaneous nerve grafting.Methods Intercostal nerve transfer to the musculocutaneous nerve was done in 32 cases.In 20 cases, the intercostal nerve was mobilized for 10 - 13 cm.After being proved by electrical stimulation that it contains motor fibers,the intercostal nerve was transected and directly sutured with the musculocutaneous nerve.In the other 12 cases, intercostal nerve transfer to the musculocutaneous nerve via nerve graft (on average 10.2 cm in length) was done.The patients were followed for an average of 3 years to evaluate the muscle power of biceps brachii and recovery of elbow flexion.Results The rate of restoration of muscle power to MRC III or over MRC III was 75 % for direct suture group and 25 % for nerve graft group.Conclusions There was obvious recovery of elbow flexion after intercostal nerve transfer to musculocutaneous nerve.The result of direct suture was superior to that of nerve grafting.