健侧C7移位至桡神经改良术的解剖学基础及在全臂丛根性撕脱伤中的初步应用

Anatomic evidence of improved technique of contralateral C7 displacement to radial nerve and its primary clinical application in total brachial plexus root avulsion injury

目的:通过解剖学研究寻求健侧C7神经根移位治疗全臂丛神经根性撕脱伤手术中尺神经与桡神经的最佳吻合部位,并观察该手术方法在临床上应用的可行性。方法:在12具24侧甲醛固定的成人尸体上观察桡神经及其肱三头肌肌支的解剖学特征;尺神经的解剖学特征;尺神经不同水平与对侧颈根部的距离。2001/2003用健侧C7移位至桡神经改良术治疗全臂丛根性撕脱伤患者共9例,手术分3步完成:I期手术在探察锁骨上下臂丛神经损伤的同时,将桡神经从后侧束发出部位切断,预置于锁骨下的皮下组织内;II期从肘部开始切取尺神经,逆行分离至锁骨下区尺神经自内侧束发出部位,通过皮下隧道将尺神经远端引至对侧颈根部,与健侧C7神经根吻合;III期手术在锁骨下区完成尺神经与桡神经的吻合。结果:解剖学研究显示:桡神经从后侧束发出部位到发出肱三头肌长头的第一支肌支之间的距离为(8.2±1.4)cm,从发出长头的第一个肌支部位到外侧头最后一个肌支发出部位之间的距离为(4.8±0.7)cm。尺神经肘部以上几乎无分支,尺神经在发出部位的直径为(6.7±0.6)mm;在肘部的直径为(6.3±0.5)mm;在腕部的直径为(4.0±0.4)mm;从锁骨下尺神经发出部位到肘部的长度为(29.0±2.6)cm;从锁骨下尺神经发出点到对侧颈根部的距离为(18.0±1.8)cm。临床显示:手术过程顺?

AIM:To seek for the best anastomosis site of the ulnar and radial nerve to improve the contralateral C7 transfer operation by anatomy study, and to observe the application feasibility of the new method in clinic. METHODS:Twelve adult cadavers(24 upper limbs) were studied to investigate anatomic features of radial nerve and the branchs of triceps,ulnar nerve, and the distance between the nerves and contralateral neck.From 2001 to 2003,9 patients with total brachial plexus root avulsion injury were treated by improved operation.The operation was performed for three stages.The first phase was to examine the injury of nerve of the brachial plexus upperclavicle and infraclavicle,sever the radial nerve at its origin in the fasciculus posterior and fix the head of radial nerve in subcutaneous and mark it; the second was to cut ulnar nerve around elbow, from medial cord to the ulnar nerve in infraclavicular area in the adverse direction,which directed ulnar nerve to contralateral neck through subcutaneous tunnel,to anastomose C7 and nerve root; the third stage was to anastomose the ulnar nerve and radial nerve in infraclavicular area. RESULTS:Anatomy research shows that the distance of radial nerve from its origin to the first branch of long head of triceps was (8.2±1.4) cm;distance of the first nerve branch of triceps long head and the last branch of lateral head was (4.8±0.7) cm.Ulnar nerve nearly has no branch over elbow and the diameter was (6.7±0.6) mm in its infraclavicular area,(6.3±0.5) mm in elbow, (4.0 ±0.4) mm in wrist. The distance from the origin of ulnar nerve to elbow and to contralateral neck was(29.0±2.6) cm and (18.0±1.8) cm,respectively.Clinic displays that operation went successfully and patients were in good status after operation, while a further follow up was needed to investigate the long term function condition. CONCLUSION:The best anastomosis site of ulnar and radial nerve is the infraclavicular area for transferring contralateral C7 root to radial nerve. This developed method not only increases the possibility of functional recovery of triceps but also shortens the length of bridge nerve.The main point of the technical development is to simplify the operative procedure and shorten the regeneration time from donor nerve to receptor nerve, which patients prefer.