新疆地区健侧C7移位术治疗全臂丛根性撕脱伤远期疗效观察

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region

目的探讨全臂丛根性撕脱伤行健侧第7颈神经(C)移位术治疗后远期功能恢复情况及术后对健侧肢体的影响。方法2004年9月-2014年12月,应用健侧C移位术治疗全臂丛根性撕脱伤并成功随访83例,其中健侧C,移位到正中神经33例、桡神经14例、肌皮神经22例,同时移位到正中神经和肌皮神经14例。随访内容包括患肢受体神经所支配肌肉的肌力恢复情况及支配区域皮肤感觉恢复情况、双侧肢体协同活动及术后对健侧肢体功能的影响等情况。结果纳人本研究患者术后均成功随访3.2~6.2年,平均4.5年,术后对健侧肢体功能无明显影响。移位于正中神经患者肌力恢复≥M,者10例,感觉恢复≥S,者26例;移位于桡神经患者,肌力恢复≥M,者6例,感觉恢复≥S,者9例;移位于肌皮神经患者,肌力恢复≥M,者12例,感觉恢复≥S,者17例;同时移位于正中神经和肌皮神经,屈腕及屈指肌力≥M,者6例,屈肘肌力≥M,者5例,正中神经支配区域感觉恢复≥S,者9例,前臂外侧皮肤感觉恢复≥S,者10例。结论健侧C移位术是一种治疗全臂丛根性撕脱伤疗效确切的较理想术式,可获得较好的临床疗效。

Objective To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C)transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation.Methods A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September,2004 to December,2014.Among them,contralateral C7 were transferred to the median nerve in 33 cases,to radial nerve in 14 cases,to musculocutaneous nerve in 22 cases,and simultaneous transfer to median and musculocutaneous nerve in 14 cases.The fllowed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve,bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery.Results All 83 cases were successfully followed-up for 3.2-6.2 years(average,4.5 years),and found no significant ffct on function of the contralateral limbs.In the group of C7 transferred to the median nerve group,10 cases had muscle strength recov-ered≥M3,and 26 cases had sensory recovered≥Ss;In the group of Cn transferred to the radial nerve,6 cases had muscle strength recovered≥M3,and 9 cases had sensory recovered≥S;In the group of C7 transferred to the musculocutaneous nerve,12 cases had muscle strength recovered≥M3,and 17 cases had sensory recovered≥Sz In the group of C7 simultaneous transferred to the median and musculocutaneous nerve,6 cases had muscle strength of wrist and digital flexion recovered≥M3,5 cases had elbow flexion recovered≥M3,9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S,respectively.Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.