健侧C_7神经根移位至桡神经治疗全臂丛神经根性撕脱伤

Clinical investigation of contrala teral C_7root transfer to the radial nerve for total brachial plexus root avulsion injury

目的观察健侧C7神经根移位至桡神经治疗全臂丛神经根性撕脱伤的临床疗效。方法1993～1999年,用健侧C7神经根移位至桡神经治疗全臂丛神经根性撕脱伤107例,36例获得2年以上随访。男31例,女5例;年龄7～44岁,平均27岁。受伤距第一次神经移位手术的时间为3～36个月,其中3～6个月4例,6～12个月29例,12～24个月2例,24～36个月1例,平均间隔时间9.4个月。整个手术过程分三期完成。第一期:锁骨上下臂丛神经探查,将膈神经移位至上干前股或通过神经桥接至肌皮神经;副神经移位至肩胛上神经;正中神经腋前区皮下预置。第二期:健侧C7神经根移位至用于桥接的尺神经。第三期:肋间神经移位至正中神经,肋间神经移位至胸背神经;尺神经与桡神经吻合术。36例患者随访时间为24～84个月,平均38个月。随访指标包括:桡神经支配肌肉运动改善情况,肌肉再生电位恢复情况,桡神经支配区皮肤感觉变化。结果运动功能改善者29例,占患者总数的80.6%;感觉功能改善者27例,占75.0%。结论健侧C7神经根移位至桡神经治疗全臂丛神经根性撕脱伤总体效果满意,但肱三头肌功能恢复欠佳。

Objective To observe the effect of contralateral C 7 root transfer to the radial nerve for the treatment of total brachial plexus root avulsion injury.Methods One hundred and seven patients with total brachial plexus root avulsion injury were treated by contralatera l C 7 root transfer to the radial nerve fro m1993to 1999.Among them 36patients were followed-up for more than 2years;there were 31male and 5female patients,with age ranged fro m 7to 44years,and 27years in average.The time of initial surgery from the time of injury was between 3to 36months,among which 4patients were tr eated between 3to 6months,29between 6to 12months,2between 12to24months and 1between 24to 36months;9.4months on the average.The whole surgical procedure was divided into three phases.Phase I:The exploration of the brachial plexus both above and below the clavicle;the phrenic nerve was transferr ed to the anterior branch of the su-perior trunk or was anastomosed with the musculocutaneous nerve;the accessory nerve was transferred to the supraclavicular nerve;the median nerve was previously placed subcutaneously at the anterior re gion of the arm-pit.PhaseⅡ:The contralateral C 7 nerve root was transferred to the uln ar nerve which was used for the bridging.PhaseⅢ:The intercostal nerve was transferred to the median nerve and the thorac odorsal nerve,the ulnar nerve and the radial nerve was a nastomosed.Patients were followed-up for 24months to 84months,38months on average.The follow-up sta ndards included:the recovery of the motor function of the muscles in-nervated by the radial nerve;the rec overy of the regeneration potential of the muscles;the change in the sensory function in the cutaneous re gion innervated by the radial nerve.Results Twenty-nine patients(80.6%of all)was improved in motor function,and 27patients(75.0%)in sensory function.Conclusion The overall effect of contralateral C 7 root transfer to the radial nerve for total brachial plexus root avulsion injury was satisfactory,while the functio nal recovery of triceps was not as exp ected.[