臂丛神经根性撕脱伤的治疗

Treatment of nerve root avulsion of brachial plexus

神经移位术是治疗臂丛根性撕脱伤的主要方法。臂丛丛外移位神经包括肋间神经(Tsuyama1969)、副神经(Kotani1970)、颈丛运动支(Brunelli1977)、膈神经(顾玉东1970)、健侧颈7神经根(顾玉东1986)等。其中,健侧颈7根移位神经纤维数量最多,安全有效,已被国内外广泛应用。近年来,胸腔镜下超长切取膈神经,有效缩短了神经再生时间。对颈5、6根性撕脱伤,改良的Oberlin术式———臂丛丛内部分尺神经或正中神经移位修复肌皮神经肱二头肌支,手术简单,屈肘功能疗效肯定;同侧颈7根移位术有效且能恢复多组肌肉功能。对颈8胸1根性撕脱伤,肌皮神经肱肌肌支移位修复正中神经屈指肌束或骨间前神经以恢复屈指功能。对全臂丛根性撕脱伤,改良的Doi术式———双股薄肌移位联合神经移位较好恢复了手握持功能;肢体短缩,健侧颈7移位直接修复正中、尺神经,能恢复屈拇屈指功能,但手内肌功能仍无恢复。如何重建手内肌仍需作进一步探索。

Nerve transfer is a main method of treating nerve root avul sion of brachial plexus. The transferred nerves from extra-brachial plexus incl ude intercostal nerves(Tsuyama 1969), accessory nerve(Kotani 1970), motor branch es of cervical plexus(Brunelli 1977), phrenic nerve(Gu 1970), contralateral C7 r oot(Gu 1986), and so on. The contralateral C7 root transfer is a safe and effect ive method, which involves the most transferred nerve fibres and is widly applie d in China and abroad. The current phrenic nerve transfer, in which full-length phrenic nerve is harvested under thoracoscope, can effectively shorten the time of nerve regeneration. For the C5,C6 root avulsion, modified Oberlins method, or intra-brachial plexus transfer of partial bundles of ulnar or median nerves to repair the biceps branch of the musculocutaneous nerve, is an easy operatio n and the recovery of elbow flexion is surely positive. Ipsilateral C7 root tran sfer is also an effective operarive method and can restore the function of some muscle groups. For C8,T1 root avulsion, the transfer of branch to brachial muscl e of the musculocutaneous nerve can restore the finger flexion by repairing the branchs to fingers flexion muscles or anterior interosseous nerve of the median nerve. For the total root avulsion of brachial plexus, double gracilis transplan tation combined with nerve transfer, a modified Dois method, can better restor e the prehension function of the hand. The operation of limb shortening combined with contralateral C7 root transfer which directly repairs the median and ulnar nerves, can restore the function of fingers flexion, but the instric muscle fun ction of hand can not be restored. How to reconstruct the instric muscle functio n of hand is still a problem which needs further research.