臂丛神经损伤的显微外科治疗(附73例报告)

Microsurgical treatment of brachial plexus injury

对 73例臂丛神经损伤患者采用显微外科治疗 ,包括直接外膜缝合、多组束膜缝合 ,膈神经、副神经、肋间神经、健侧C7神经根移位带血管尺神经移植桥接修复 ,小隐静脉动脉化隐神经移植 ,游离神经移植修复等方法。结果 :术后 5 0例随访 14年 ,9例随访 <1年。其中 41例有不同程度的肌力恢复 ,臂丛根性撕脱伤的神经移位治疗效果尚可。本组功能恢复较满意 ,其中 49例行支配肩关节外展的神经移位修复 ,外展功能恢复 >3 0°者 2 0例 ( 40 .8% )。 5 8例行支配肘关节屈肘的神经移位修复 ,屈肘恢复的有效率者 3 7例 ( 63 .8% )。 14例行支配屈腕指功能的神经修复 ,屈腕指活动恢复者 5例 ( 3 5 .8% )。 48例上肢感觉有恢复者 41例 ( 85 .4% )。其中 1例刀砍伤全臂丛离断患者上肢肌力恢复至肌力 5级 (M5)。

To summarize microsurgical repair methods and results of brachial plexus injury,73 patients with brachial plexus injury were treated with microsurgical suture;phrenic nerve, accessory nerve,intercostals nerve and contralateral C 7 neurotizations;free sural nerve graft.Activities and sensation of upper extremitis was analyzed. 50 patients were follow-up 1~4 years,among of them 41 cases were recover of muscle strength.Shoulder abduction more than 30° was achieved in 40.8%(20/49) of the patients.The effective elbow flexions achieved in 63.8%(37/58) of the patients.Wrist and finger flexions recovered in 35.8%(5/14) of patients.Upper extremities protective sensory recovered in 85.4%(41/48) of patients.1 case patient with chopped wound of brachial plexus trunk recovered completely.This suggests that microsurgical treatment of brachial plexus injury is a good method and treating result was satisfactory.