多组神经移位联合肌肉移植(位)治疗臂丛神经根性撕脱伤(附10例报告)

Effect of nerve fascicle of groups transfer unite the muscling to transplant to treat the brachial plexus root avulsion injury

目的 探讨多组神经移位联合肌肉移植 (位 )治疗臂丛神经根性撕脱伤的临床效果。方法 设计手术分三期。一期膈神经移位至肌皮神经 ,副神经移位至肩胛上神经 ,健侧颈 7移位至患侧尺神经恢复肩外展及屈肘功能 ;二、三期手术用股薄肌、健侧背阔肌移植或患侧背阔肌移位 (早期 )的方法重建屈、伸指功能。结果 10例患者其中全臂丛神经损伤 8例 ,颈 5、6、7、8神经损伤 2例。全部病例随访 1年以上。肌皮瓣全部成活 ,移植肌肉一年以后肌力达 M3～ M4 。结论 多组神经移位联合肌肉移植是治疗臂丛神经损伤的有效方法 。

Objective To explore the result of nerve fascicle of groups transfer unite the muscling to transplant to treat the brachial plexus root avulsion injury Methods Nerve fascicle of groups transfer unite the muscling to transplant to treat the brachial plexus root avulsion injury was designed since 2000 The whole surgical procedure was divided into three phases Phases Ⅰ:the phrenic nerve was transferred to the musculocutaneous nerve;the accessory nerve was transferred to the suprascapular nerve;the contra lateral C 7 nerve root was transferred to the lunar nerve of ill recover the function of shoulder joint to stretch and crooded elbow PhasesⅡ,Ⅲ:gracilis,altissimo dorsa of contra lateral to transplant or altissimo dorsa of ill to transfer(earlier period)to recover the function of fingers crooked or stretch 10 patients were treated Among them 8 patients were total brachial plexus root avulsion injury 2 patients were C 5?6?7?8 injury All patients were followed up more than one year Results All 10 patients myocutaneous flaps were survived,the muscle powers were of M 3～M 4 after a year Conclusion Nerve fascicle of groups transfer unite the muscling to transplant is a valid method to treat the brachial plexus root avulsion injury,earlier period can choose altissimo dorsa of ill to transfer