不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效比较

Comparison of the therapeutic effects of nerve transfer at different sites for repairing brachial plexus root avulsion injury

目的分析不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效,并探讨手术效果影响因素。方法选取2011-01—2017-12平顶山市第五人民医院骨科收治的行神经移位修复术治疗臂丛神经根性撕脱伤患者94例作为研究对象,分别行健侧颈7神经移位术(32例)、肋间神经移位术(30例)及膈神经移位术(32例),收集患者基本资料,并对患者术后患肢肘关节功能及肌力恢复情况进行评估。结果3组患者肘关节恢复达到良以上分别为膈神经组21例(65.6%),肋间神经组20例(66.7%),C7神经组23例(71.9%),3组患者术后肘关节功能恢复情况比较,差异无统计学意义(P>0.05)。术后膈神经组、肋间神经组,C7神经组肌力≥Ⅲ级的例数分别为25例(78.1%)、22例(73.3%)、25例(78.1%),3组患者术后患肢肌力恢复情况无显著性差异(P>0.05)。3组术后肘关节功能恢复的影响因素存在差异。(1)膈神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P<0.05);(2)肋间神经组术后肘关节功能恢复情况与功能锻炼时间、损伤部位和神经移植长度等因素有关(P均<0.05);(3)C7神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度等因素有关(P<0.05)。与3组患者术后肘关节功能恢复情况均有关的影响因素为神经移植长度。3组患者术后肌力恢复的影响因素存在差异。(1)膈神经组肌力恢复情况与患者年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P均<0.01);(2)肋间神经组肌力恢复情况与年龄、功能锻炼时间和神经移植长度等因素有关(P均<0.01);(3)颈7神经组肌力恢复情况与年龄、功能锻炼时间及损伤-手术时间等因素有关(P均<0.01)。结论3种供体神经移植修复臂丛神经根性撕脱伤效果相当,但术后效果的影响因素不尽相同,因此根据患者具体情况选择最优的治疗方式,有利于提高手术有效率。

Objective To analyze the effect of nerve donors from different sources on the repair of brachial plexus root avulsion and to explore the influencing factors.Methods From January 2011 to December 2017,94 cases of brachial plexus root avulsion treated by nerve transfer repair were selected as the research objects,and C7 nerve transfer on the healthy side(32 cases),intercostal nerve transfer(30 cases)and phrenic nerve transfer(32 cases)were performed respectively.The basic data of the patients were collected,and the elbow joint function and muscle strength recovery of the affected limb were analyzed Assessment.Results The recovery of elbow joint in the three groups were as follows21 cases in phrenic nerve group(65.6%),20 cases in intercostal nerve group(66.7%),23 cases in C7 nerve group(71.9%).There was no significant difference between the three groups(P>0.05).There were 25 cases(78.1%),22 cases(73.3%)and 25 cases(78.1%)in phrenic nerve group,intercostal nerve group and C7 nerve group,respectively.There was no significant difference between the three groups(P>0.05).The influencing factors of elbow joint function recovery were different in three groups.(1)The functional recovery of elbow joint in phrenic nerve group was related to age,injury operation time,nerve transplantation length and functional exercise time(P<0.05);(2)the functional recovery of elbow joint in intercostal nerve group was related to functional exercise time,injury site and nerve transplantation length(P<0.05);(3)the functional recovery of elbow joint in C7 nerve group was related to age and injury-The time of operation and the length of nerve transplantation were related(P<0.05).The factors related to the functional recovery of elbow joint were the length of nerve transplantation.There were differences in the influencing factors of muscle strength recovery among the three groups.(1)The recovery of muscle strength in phrenic nerve group was related to age,injury operation time,nerve transplantation length and functional exercise time(P<0.01);(2)the recovery of muscle strength in intercostal nerve group was related to age,functional exercise time and nerve transplantation length(P<0.01);(3)the recovery of muscle strength in C7 nerve group was related to age,functional exercise time and injury operation time.Conclusion The three kinds of donor nerve transplantation have the same effect in the repair of brachial plexus root avulsion,but the influence factors of the effect are not the same.Therefore,according to the specific situation of patients,choosing the best treatment is conducive to improve the efficiency of the operation.