中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2010年
8期
758-763
,共6页
王树锋%李玉成%栗鹏程%王海华%褚寅%薛云皓%胡琪%赵俊会
王樹鋒%李玉成%慄鵬程%王海華%褚寅%薛雲皓%鬍琪%趙俊會
왕수봉%리옥성%률붕정%왕해화%저인%설운호%호기%조준회
臂丛%神经移位%手术后并发症
臂叢%神經移位%手術後併髮癥
비총%신경이위%수술후병발증
Brachial plexus%Nerve transfer%Postoperative complications
目的 分析健侧C7神经经椎体前通路移位修复臂丛神经损伤相关并发症的发生原因,并提出防治方法 .方法 自2002年2月至2009年8月,共完成425例健侧C7神经经椎体前通路移位术,男379例,女46例;年龄3个月～56岁,平均21岁.创伤性臂丛神经损伤401例,分娩性臂丛神经损伤24例.健侧C7神经自干平面切断15例,将前后股向远端做干支分离后在其远端切断410例.将并发症分为与椎体前通路制备、与健侧C7神经切取及围手术期其他严重并发症.结果 并发症发生率为5.18%(22/425).与椎体前通路制备相关的并发症:椎动脉损伤0.47%(2/425),喉返神经牵拉伤致声音嘶哑1.18%(5/425),进食时健侧上肢麻木与疼痛0.94%(4/425).与健侧C7神经切取相关的并发症:健侧伸指、伸拇功能障碍0.94%(4/425),健侧上肢术后出现严重疼痛0.71%(3/425),健侧出现Horner征0.47%(2/425),C7神经根错切0.24%(1/425).其他围手术期严重并发症0.24%(1/425),1例患者术后第2天出现脑干栓塞症状,逐渐出现呼吸、循环衰竭,术后第38天死亡.结论 健侧C7神经经椎体前通路移位安全.椎动脉损伤的发生率虽然很低,但其是椎体前通路移位的严重并发症,显露椎动脉起始段后,直视下进行操作是防止此并发症的有效方法.
目的 分析健側C7神經經椎體前通路移位脩複臂叢神經損傷相關併髮癥的髮生原因,併提齣防治方法 .方法 自2002年2月至2009年8月,共完成425例健側C7神經經椎體前通路移位術,男379例,女46例;年齡3箇月～56歲,平均21歲.創傷性臂叢神經損傷401例,分娩性臂叢神經損傷24例.健側C7神經自榦平麵切斷15例,將前後股嚮遠耑做榦支分離後在其遠耑切斷410例.將併髮癥分為與椎體前通路製備、與健側C7神經切取及圍手術期其他嚴重併髮癥.結果 併髮癥髮生率為5.18%(22/425).與椎體前通路製備相關的併髮癥:椎動脈損傷0.47%(2/425),喉返神經牽拉傷緻聲音嘶啞1.18%(5/425),進食時健側上肢痳木與疼痛0.94%(4/425).與健側C7神經切取相關的併髮癥:健側伸指、伸拇功能障礙0.94%(4/425),健側上肢術後齣現嚴重疼痛0.71%(3/425),健側齣現Horner徵0.47%(2/425),C7神經根錯切0.24%(1/425).其他圍手術期嚴重併髮癥0.24%(1/425),1例患者術後第2天齣現腦榦栓塞癥狀,逐漸齣現呼吸、循環衰竭,術後第38天死亡.結論 健側C7神經經椎體前通路移位安全.椎動脈損傷的髮生率雖然很低,但其是椎體前通路移位的嚴重併髮癥,顯露椎動脈起始段後,直視下進行操作是防止此併髮癥的有效方法.
목적 분석건측C7신경경추체전통로이위수복비총신경손상상관병발증적발생원인,병제출방치방법 .방법 자2002년2월지2009년8월,공완성425례건측C7신경경추체전통로이위술,남379례,녀46례;년령3개월～56세,평균21세.창상성비총신경손상401례,분면성비총신경손상24례.건측C7신경자간평면절단15례,장전후고향원단주간지분리후재기원단절단410례.장병발증분위여추체전통로제비、여건측C7신경절취급위수술기기타엄중병발증.결과 병발증발생솔위5.18%(22/425).여추체전통로제비상관적병발증:추동맥손상0.47%(2/425),후반신경견랍상치성음시아1.18%(5/425),진식시건측상지마목여동통0.94%(4/425).여건측C7신경절취상관적병발증:건측신지、신무공능장애0.94%(4/425),건측상지술후출현엄중동통0.71%(3/425),건측출현Horner정0.47%(2/425),C7신경근착절0.24%(1/425).기타위수술기엄중병발증0.24%(1/425),1례환자술후제2천출현뇌간전새증상,축점출현호흡、순배쇠갈,술후제38천사망.결론 건측C7신경경추체전통로이위안전.추동맥손상적발생솔수연흔저,단기시추체전통로이위적엄중병발증,현로추동맥기시단후,직시하진행조작시방지차병발증적유효방법.
Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years (range, 3 months to 56 years). The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%(22/425). The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner's sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route.
