全臂丛根性撕脱伤后神经移位联合早期股薄肌移植重建术

Reconstruction after complete root avulsion of brachial plexus by nerve transfer combined with gracilis transplantation at early stage

目的 探讨重建全臂丛根性撕脱伤后上肢主要功能的新方法。方法 8例全臂丛根性撕脱伤后2～4月一期行膈神经移位修复肩胛上神经,联合对侧股薄肌移植重建屈肘、伸指伸拇5例或屈拇屈指3例。前者其中2例二期再行同侧股薄肌移植重建屈拇屈指等。结果 一期手术1年以上5例,术后4～5月移植肌肉出现收缩,5～7月伸指伸拇或屈拇屈指、屈肘,12月屈肘60°～90°、肌力M_4,伸拇伸指或屈拇屈指M_3～M_4,肩外展30°～60°、M_3。二期手术的1例术后7月移植肌肉收缩,12月屈拇屈指M_4。重建屈拇屈指者可握持物品。结论 神经移位联合早期股薄肌移植,可在短时间内恢复全臂丛根性撕脱伤肢体的部分功能,初步重建手握持功能。

Objective To devise a new procedure reconstructing the main function of upper limb after complete root avulsion of brachial plexus. Methods Eight patients underwent reconstruction by phernic nerve transfer to suprascapular nerve for shouder abduction combined with vascularized contralateral gracilis transplantation neurotized by spinal accessory nerve for elbow flexion and fingers and thumb extension in five cases at first operation, or for elbow, fingers and thumb flexion in three cases. Two of the former were reconstructed fingers and thumb flexion by colateral gracilis transplantation reinnervated by forth to sixth intercostal motor nerves . Results Five patients after first operation were fellow-up over 12 months. The voluntary contraction of transplating gracilis were detected in four to five months. Fingers could extentd or flex and elbow flex in five to seven months. In 12 months elbow flexion was 60°-90° and M4. Fingers extension or flexion were Ms ~ Mi. Shoulder extension were 30°-60°and M3. One patients after second operation revealed gracilis contraction in seven months. In 12 months, thumb and finger flexion was M4. The patients who had restored the thumb and fingers flexion were able to achieve prehensile functions. Conclusion Reconstruction of the complete root avulsion of brachial plexus by nerve transfer combined with gracilis transplantation at early stage, could restore partially the upper limb functions in a short time and construct hand prehension preliminarily.