中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2009年
6期
444-447
,共4页
顾立强%向剑平%秦本刚%李平%戚剑%朱庆棠%傅国%王洪刚%劳镇国%刘小林%朱家恺
顧立彊%嚮劍平%秦本剛%李平%慼劍%硃慶棠%傅國%王洪剛%勞鎮國%劉小林%硃傢愷
고립강%향검평%진본강%리평%척검%주경당%부국%왕홍강%로진국%류소림%주가개
臂丛%根部撕脱伤%神经移位术%健侧颈_7%椎体前路%股薄肌%移植
臂叢%根部撕脫傷%神經移位術%健側頸_7%椎體前路%股薄肌%移植
비총%근부시탈상%신경이위술%건측경_7%추체전로%고박기%이식
Brachial plexus%Root avulsion%Nerve transfer%Contralateral C_7%Prespinal route%Gracilis%Transplantation
目的 探讨健侧颈7神经椎体前路移位直接修复下干联合功能性股薄肌移植重建术治疗全臂丛根部撕脱伤的手术设计及其临床疗效.方法 12例全臂丛根性撕脱伤患者,于伤后1～3个月行臂丛神经根干部探查,一期健侧颈,经椎体前路移位直接修复患侧C_8T_1-下干,同时行膈神经移位修复肩胛上神经9例.于一期术后4-8个月分别行二期吻合血管的股薄肌移植(以副神经斜方肌支为缝接神经)重建屈肘、伸指伸拇功能.结果 随访9～36个月.一期术后3个月12例患侧尺神经、正中神经Tinel征至上臂近段平面,术后6个月至肘关节与前臂近段平面,9个月至前臂远段与腕部.9例12个月Tinel征至手掌、手指部.7例术后9个月胸大肌胸肋部收缩,12个月肩内收可夹持物品;5例术后15-18个月手掌、手指与前臂内侧均有触痛觉恢复,尺侧腕屈肌和示、中、环、小指屈指肌收缩.3例术后24个月,拇指屈曲,1例鱼际肌出现收缩(M_1).二期股薄肌移植功能重建术后有7例于二期术后4～7个月移植肌肉收缩;9～12个月屈肘90°～120°(M_3),伸指伸拇M_3 .结论 健侧颈_7神经经椎体前路移位直接修复C_8T_1-下干术,联合二期股薄肌移植重建屈肘、伸指伸拇功能治疗全臂丛根部撕脱伤的手术设计具有可操作性,初步观察神经再生进程顺利,能恢复手腕、手指的屈曲与感觉功能,重建屈肘、伸指功能.
目的 探討健側頸7神經椎體前路移位直接脩複下榦聯閤功能性股薄肌移植重建術治療全臂叢根部撕脫傷的手術設計及其臨床療效.方法 12例全臂叢根性撕脫傷患者,于傷後1～3箇月行臂叢神經根榦部探查,一期健側頸,經椎體前路移位直接脩複患側C_8T_1-下榦,同時行膈神經移位脩複肩胛上神經9例.于一期術後4-8箇月分彆行二期吻閤血管的股薄肌移植(以副神經斜方肌支為縫接神經)重建屈肘、伸指伸拇功能.結果 隨訪9～36箇月.一期術後3箇月12例患側呎神經、正中神經Tinel徵至上臂近段平麵,術後6箇月至肘關節與前臂近段平麵,9箇月至前臂遠段與腕部.9例12箇月Tinel徵至手掌、手指部.7例術後9箇月胸大肌胸肋部收縮,12箇月肩內收可夾持物品;5例術後15-18箇月手掌、手指與前臂內側均有觸痛覺恢複,呎側腕屈肌和示、中、環、小指屈指肌收縮.3例術後24箇月,拇指屈麯,1例魚際肌齣現收縮(M_1).二期股薄肌移植功能重建術後有7例于二期術後4～7箇月移植肌肉收縮;9～12箇月屈肘90°～120°(M_3),伸指伸拇M_3 .結論 健側頸_7神經經椎體前路移位直接脩複C_8T_1-下榦術,聯閤二期股薄肌移植重建屈肘、伸指伸拇功能治療全臂叢根部撕脫傷的手術設計具有可操作性,初步觀察神經再生進程順利,能恢複手腕、手指的屈麯與感覺功能,重建屈肘、伸指功能.
목적 탐토건측경7신경추체전로이위직접수복하간연합공능성고박기이식중건술치료전비총근부시탈상적수술설계급기림상료효.방법 12례전비총근성시탈상환자,우상후1～3개월행비총신경근간부탐사,일기건측경,경추체전로이위직접수복환측C_8T_1-하간,동시행격신경이위수복견갑상신경9례.우일기술후4-8개월분별행이기문합혈관적고박기이식(이부신경사방기지위봉접신경)중건굴주、신지신무공능.결과 수방9～36개월.일기술후3개월12례환측척신경、정중신경Tinel정지상비근단평면,술후6개월지주관절여전비근단평면,9개월지전비원단여완부.9례12개월Tinel정지수장、수지부.7례술후9개월흉대기흉륵부수축,12개월견내수가협지물품;5례술후15-18개월수장、수지여전비내측균유촉통각회복,척측완굴기화시、중、배、소지굴지기수축.3례술후24개월,무지굴곡,1례어제기출현수축(M_1).이기고박기이식공능중건술후유7례우이기술후4～7개월이식기육수축;9～12개월굴주90°～120°(M_3),신지신무M_3 .결론 건측경_7신경경추체전로이위직접수복C_8T_1-하간술,연합이기고박기이식중건굴주、신지신무공능치료전비총근부시탈상적수술설계구유가조작성,초보관찰신경재생진정순리,능회복수완、수지적굴곡여감각공능,중건굴주、신지공능.
Objective To explore the clinical design and therapeutic effect of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation. Methods Twelve cases of total roots avulsion of brachial plexus were operated at 1 month to 3 months after injury.The contralateral C_7 nerve was successfully transferred to directly repair avulsed C_8T_1 roots or lower trunk via prespinal route.At 2nd operation stage after 4 to 8 months,the functioning gracills transplantation was preformed to reconstruct the elbow flexion and fingers extension. Results Follow-ups were carried out in all 12 cases who had been discharged for 9 to 36 months after the first operation.The positive Tinel signs of ulnar or median nerves were located in the proximal arm at 3 months after 1st operation,in the elbow or proximal forarm at 6 months,and in the wrist or distal forarm at 9 months.At 12 months the positive Tinel signs were found in the plam or fingers in 9 cases.The contraction of sternocostal part of pectoralis major was found at 9 mooths in 7 cases.There were the restoration of the taction-pain sensation in the palm, finger, and medial side of forearm and the contraction of flexor carpi ulnaris and flexor digitorum(M_3)in 5 cases at 15 to 18 months after 1st operation.In 7 patients the flexion of elbow and extension of fingers and thumb restored at 9 to 12 months after the 2nd operation.Their elbow flexion was 90°-120°and M_3(Highet's method),and their finger and thumb extension M_3. Conclusion There is the possibility of the operative design and clinical application of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation.There are not only the restoration of sensation and flexion of wrist and fingers,but also the restoration of elbow flexion and fingers extension.
