CAJ | 학술논문

目的探讨选择性健侧C7神经根移位术的可靠性以及影响手术效果的因素.方法对46例在华山医院手外科接受健侧C7神经根移位术的全臂丛神经根性撕脱伤的患者进行随访,手术分两期进行,受体神经均为正中神经主干.其中切取C7神经根全根者8例,保留前股前内侧束者14例,仅切取前股或后股者24例.随访内容包括患肢屈腕、屈指肌力以及桡侧三指掌侧皮肤感觉的检测(英国医学研究委员会标准).结果 46例接受健侧C7神经根移位术的患者中,运动功能有效恢复率为47.83%(22/46),感觉功能有效恢复率为56.52%(26/46).健侧C7神经根的切取面积越大,术后患肢运动功能恢复的有效率越高,各组间的差异具有统计学意义(P<0.05);但感觉功能恢复情况之间的差异无统计学意义(P>0.05).两期手术的间隔时间在4～8个月的患者,其术后运动功能恢复情况明显好于其余两组,差异具有统计学意义(P<0.05),但感觉功能恢复情况之间的差异无统计学意义(P>0.05);受伤至接受一期手术的间隔时间不同的患者,其术后运动及感觉功能恢复情况之间的差异均没有显著的统计学意义(P>0.05).结论选择性健侧C7神经移位术是治疗臂丛神经根性撕脱伤的有效术式,但切取全根者效果更好;两期手术的间隔时间应控制在4～8个月,这样将获得更好的功能恢复;受伤至接受手术的间隔时间也是影响手术效果的重要因素,手术进行得越早,获得的功能恢复越好.
목적 탐토선택성건측C7신경근이위술적가고성이급영향수술효과적인소.방법 대46례재화산의원수외과접수건측C7신경근이위술적전비총신경근성시탈상적환자진행수방,수술분량기진행,수체신경균위정중신경주간.기중절취C7신경근전근자8례,보류전고전내측속자14례,부절취전고혹후고자24례.수방내용포괄환지굴완、굴지기력이급뇨측삼지장측피부감각적검측(영국의학연구위원회표준).결과 46례접수건측C7신경근이위술적환자중,운동공능유효회복솔위47.83%(22/46),감각공능유효회복솔위56.52%(26/46).건측C7신경근적절취면적월대,술후환지운동공능회복적유효솔월고,각조간적차이구유통계학의의(P<0.05);단감각공능회복정황지간적차이무통계학의의(P>0.05).량기수술적간격시간재4～8개월적환자,기술후운동공능회복정황명현호우기여량조,차이구유통계학의의(P<0.05),단감각공능회복정황지간적차이무통계학의의(P>0.05);수상지접수일기수술적간격시간불동적환자,기술후운동급감각공능회복정황지간적차이균몰유현저적통계학의의(P>0.05).결론 선택성건측C7신경이위술시치료비총신경근성시탈상적유효술식,단절취전근자효과경호;량기수술적간격시간응공제재4～8개월,저양장획득경호적공능회복;수상지접수수술적간격시간야시영향수술효과적중요인소,수술진행득월조,획득적공능회복월호.
Objective To evaluate the long term outcome of patients treated with selective contralateral C7 transfer and to determine the factors affecting the outcomes of treatment. Methods Forty-six patients with total brachial plexus avulsion injuries were involved in this serial. All of the surgeries were performed by two stages and median nerve was the recipient nerve. Tne contralateral C7 nerve was used in three different ways. The whole root was used in eight patients; the major part except the anterior and medial part of the anterior division was used in 14 patients; the anterior or the posterior division was used in 24 patients. The functions of all the patients were evaluated by the British Medical Research Council (MRC) scale. Results The entire effective rate was 47.83% (22/46) in motor function and 56.52% (26/46) in sensory function. The more nerve fibers of C7 were used the better motor function were obtained. A better result of motor recovery could be induced if the interval between two stages was within four to eight months. And there seemed no statistically significant( P >0.05) in either motor or sensory function recovery with the difference of post trauma time. Conclusion Selective contralateral C7 transfer is an effective procedure in treating total brachial plexus avulsion injury. The more nerve fibers of C7 are used the better function recovery can be obtained and the ideal interval between two stages is four to eight months. The posttrauma time should be another key factor, and the surgery ought to be performed as early as possible.