臂丛神经损伤患者膈神经移植肌皮神经的电生理观察

Electrophysiological observation of transplantation of phrenic nerves as musculocutaneous nerves of patients with brachial plexus injury

目的：评估膈神经功能测定在臂丛神经损伤神经移植前的应用价值，术后电生理观察神经移植恢复状况。方法：对50例臂丛神经损伤患者术前进行了膈神经功能测定，对其中10例膈神经功能正常者，行同侧膈神经移植肌皮神经手术，术后神经电生理随访观察肱二头肌肌电图及肌皮神经运动传导功能状况。结果：臂丛神经损伤患者约28％伴膈神经损伤，损伤的膈神经不能选择为移植动力神经。隔神经移植肌皮神经后，最早3个月出现再生电位，6个月后出现运动单位电位，12个月后运动单位电位明显增多。术后肱二头肌肌力18个月后恢复优良占80％。7例术后12个月肌皮神经引出运动神经传导电位。结论：膈神经功能测定在臂丛神经损伤患者术前可评估选择移植神经，术后电生理可随访观察神经功能恢复状况，对臂丛神经损伤患者的手术治疗有一定指导作用。

Objective：To evaluate applied phrenic nerve function determination before nerve trans‐plantation for brachial plexus and the recovery status after transplantation through electrophysiological observation .Methods：Determinations of phrenic nerve function were performed in 50 patients with brachi‐al plexus injury .The ipsilateral phrenic nerves of 10 patients with normal phrenic nerve function were transplanted as musculocutaneous nerves .Postoperative follow‐up electrophysiological observations were made on the transplanted nerves using biceps electromyograms and the motion conduction function of the musculocutaneous nerves .Results：About 28% of the patients with brachial plexus injuries also suffered from phrenic nerve injuries .The injured phrenic nerves could not be transplanted as motor nerves .The re‐productive potential appeared at least 3 months after the transplantation of phrenic nerves as musculocu‐taneous nerves .The motor unit potential appeared 6 months later and significantly increased 12 months‐later .The patients with good recovery of myodynamia of biceps muscles after transplantation accounted for 80% .Motor nerve conduction potential was detected on the postoperative musculocutaneous nerves in 7 patients 12 months after the transplantation .Conclusion：Preoperative determination of phrenic nerve functions of patients with brachial plexus injury can be used to evaluate and choose the nerves to be trans‐planted .Postoperative follow‐up electrophysiological observations contvibutes to neural functional recov‐ery and to the operative the treatment of patients with brachial plexus injury .