多组神经移位治疗全臂丛神经根性撕脱伤38例

Long-term outcomes of multiple donor nerves transfer for treatment of brachial plexus total roots avulsion

目的 探讨多组神经移位治疗臂丛神经根性撕脱伤的方法和疗效。 方法 对 38例全臂丛神经根性撕脱伤患者采用膈神经、副神经、肋间神经、健侧C7神经根移位治疗 ,并进行长期随访 ,观察肩外展、屈肘、屈指和手部感觉功能恢复的情况。 结果 37例随访 (4.91± 1.2 5 )年。肩外展 >30°占 5 7.1% (2 0 35 )。屈肘恢复的总有效率为 73.7% (2 8 38) ,屈腕指动作恢复有效率为4 4 .7% (17 38) ,其中肌力≥M3者 10例 ,优良率为 2 6 .3% (10 38)。手掌感觉恢复有效率为 5 5 .3%(2 1 38)。肋间神经修复胸背神经 ,31例有不同程度肌力恢复 ,占 81.6 % (31 38) ,其中肌力≥M3者2 4例 ,有效率为 6 3.2 % (2 4 38)。 结论 多组神经移位治疗全臂丛根性撕脱伤可获得较好疗效。

Objective To report the methods and long term outcomes of multiple donor nerves transfer for the treatment of brachial plexus total roots avulsion. Methods Thirty eight patients with brachial plexus total roots avulsion were treated with phrenic, accessory, intercostals nerve and contralateral C 7 nerve neurotizations. The long term outcomes of shoulder abduction, elbow, wrist and finger flexions and recovery of latissmus dorsi were analyzed. Results The follow up period was average (4.91±1.25) years. Shoulder abduction more than 30 degree was achieved in 57.1% (20/35) of the patients. The excellent and effective elbow flexions achieved in 73.7% (28/38) of the patients. Wrist and finger flexions recovered in 44.7% (17/38) of patients with an effective rate of 26.3% (10/38). Hand protective sensory recovered in 55.3%(21/38) of the patients. Latissmus dorsi recovered in 81.6% (31/38) of the patients and effective rate was 63.2% (24/38). Conclusions Multiple donor nerves neurotization is a good method for the treatment of brachial plexus total roots avulsion.