神经移植端侧缝合颈5/7神经根与上干桥接治疗产瘫

Bridging C_5/C_7 nerve root and upper trunk with end-to-side neurorrhaphy of grafted nerves in treatment of obstetric palsy

目的 :探讨一种不影响残存神经自行恢复的产瘫臂丛神经修复新方法。 方法 :将上干损伤部位行松解 ,不切除神经瘤 ,将其近端的颈 5或颈 7神经根和神经瘤远端的臂丛上干的神经束膜切开窗口 ,取颈丛皮支或前臂外侧皮神经剪成多段 (一般每段长约 2 .0～ 2 .5 cm ) ,两端分别与颈 5神经根和上干的神经束膜行端侧缝合。 结果 :8例患儿经术后 1～ 11年 (平均 3年 )的随访 ,4例的三角肌和肱二头肌肌力达 4级和 4- 级 ,4例达 3级。 3例后期进行了肩关节松解和旋前圆肌肌腱切断。 结论 :该方法既提供了可使损伤近端颈 5神经根的新生纤维生长至上干的神经通道 ,又未阻断神经瘤内残存神经纤维的自行恢复 ,是治疗产瘫特别是 Tassin

Objective:To introduce a new method for treatment of obstetric brachial plexus palsy preserving self recovery chance of injured nerves. Methods:After neurolysis of injured upper trunk, the cutaneous branches of cervical plexus or lateral antebrachial cutaneous nerves were taken as the donor, the grafting nerves were cut into several segments (2 2.5) cm. Then they were sutured respectively to both ends of C 5 root and the upper trunk with the perineurial window in an end to side fashion. Results: All the 8 cases were followed up for 1 to 11 years (average 3 years), the myodynamia of meltoid muscle and biceps brachii reached 4 grade and 4 grade in 2 cases, respectively; and 3 grade in 4 cases. Shoulder joint lysis and round pronator teres resection were performed in 3 patients. Conclusion: The method provides channel for new nerve fibres of C 5 to upper trunk, it does not block the self recovery of remained fibres in neuroma. It is a new method for treatment of obstetric brachial plexus palsy of Tassin 1 or 2 type.