中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2010年
4期
386-390
,共5页
王树锋%栗鹏程%李玉成%薛云皓%郑炜%孙燕琨%郜永斌%潘勇卫%胡琪%田光磊
王樹鋒%慄鵬程%李玉成%薛雲皓%鄭煒%孫燕琨%郜永斌%潘勇衛%鬍琪%田光磊
왕수봉%률붕정%리옥성%설운호%정위%손연곤%고영빈%반용위%호기%전광뢰
臂丛%颈丛%创伤和损伤%颈椎
臂叢%頸叢%創傷和損傷%頸椎
비총%경총%창상화손상%경추
Brachial plexus%Cervical plexus%Wounds and injuries%Cervical vertebrae
目的 探讨健侧C_7神经根经椎体前通路移位与患侧下干直接吻合治疗创伤性臂从撕脱伤的中期疗效.方法 2004年5月至2009年4月,采用健侧C_7与下干直接吻合治疗创伤性臂丛撕脱伤患者220例,其中64例获得3年以上的来院随访,男59例,女5例;年龄7～51岁,平均26岁.伤后到手术时间1～18个月,平均3.7个月.全臂丛撕脱伤60例,中、下干撕脱伴上干不全损伤2例,中、下干撕脱而上干正常2例.健侧C_7与下干直接吻合56例,与内侧束直接吻合8例.30例行肱骨短缩截骨,截骨长度2.6～5.8 cm,平均3.9 cm.结果 术后随访36～57个月,平均44个月.41例屈指肌力恢复到4级,3级12例,2级10例,0级1例,优良率为64.1%(41/64);34例拇长屈肌肌力为4级,3级14例,2级14例,0级2例,优良率为53.1%(34/64);47例尺侧屈腕肌力为4级,3级9例,2级7例,0级1例,优良率为73.4%(47/64);32例掌长肌肌力为4级,3级20例,2级11例,0级1例,优良率为50%(32/64).结论 健侧C_7与患侧下干直接吻合较传统的手术方法缩短了神经再生的距离及减少了一个吻合口,可显著提高其重建屈指、屈腕功能效果.
目的 探討健側C_7神經根經椎體前通路移位與患側下榦直接吻閤治療創傷性臂從撕脫傷的中期療效.方法 2004年5月至2009年4月,採用健側C_7與下榦直接吻閤治療創傷性臂叢撕脫傷患者220例,其中64例穫得3年以上的來院隨訪,男59例,女5例;年齡7～51歲,平均26歲.傷後到手術時間1～18箇月,平均3.7箇月.全臂叢撕脫傷60例,中、下榦撕脫伴上榦不全損傷2例,中、下榦撕脫而上榦正常2例.健側C_7與下榦直接吻閤56例,與內側束直接吻閤8例.30例行肱骨短縮截骨,截骨長度2.6～5.8 cm,平均3.9 cm.結果 術後隨訪36～57箇月,平均44箇月.41例屈指肌力恢複到4級,3級12例,2級10例,0級1例,優良率為64.1%(41/64);34例拇長屈肌肌力為4級,3級14例,2級14例,0級2例,優良率為53.1%(34/64);47例呎側屈腕肌力為4級,3級9例,2級7例,0級1例,優良率為73.4%(47/64);32例掌長肌肌力為4級,3級20例,2級11例,0級1例,優良率為50%(32/64).結論 健側C_7與患側下榦直接吻閤較傳統的手術方法縮短瞭神經再生的距離及減少瞭一箇吻閤口,可顯著提高其重建屈指、屈腕功能效果.
목적 탐토건측C_7신경근경추체전통로이위여환측하간직접문합치료창상성비종시탈상적중기료효.방법 2004년5월지2009년4월,채용건측C_7여하간직접문합치료창상성비총시탈상환자220례,기중64례획득3년이상적래원수방,남59례,녀5례;년령7～51세,평균26세.상후도수술시간1～18개월,평균3.7개월.전비총시탈상60례,중、하간시탈반상간불전손상2례,중、하간시탈이상간정상2례.건측C_7여하간직접문합56례,여내측속직접문합8례.30례행굉골단축절골,절골장도2.6～5.8 cm,평균3.9 cm.결과 술후수방36～57개월,평균44개월.41례굴지기력회복도4급,3급12례,2급10례,0급1례,우량솔위64.1%(41/64);34례무장굴기기력위4급,3급14례,2급14례,0급2례,우량솔위53.1%(34/64);47례척측굴완기력위4급,3급9례,2급7례,0급1례,우량솔위73.4%(47/64);32례장장기기력위4급,3급20례,2급11례,0급1례,우량솔위50%(32/64).결론 건측C_7여환측하간직접문합교전통적수술방법축단료신경재생적거리급감소료일개문합구,가현저제고기중건굴지、굴완공능효과.
Objective To observe the medium-term of functional recovery of figure and wrist flexion after the direct anastomosis of eontralateral C_7 transfered through the prespinal route with lower trunk in pa-tient suffered brachial plexus root avulsion. Methods From May 2004 to April 2009, 220 patients with brachial plexus nerve root avulsion were repaired with the direct anastomosis of contralateral C_7 transfered through the prespinal route with lower trunk. There were 59 males and 5 females. The patients ranged from 7 to 51 years old, with an average age of 26 years. The interval from injury to operation ranged 1 to 18 months, with a mean of 3.7 months. Among them, 60 cases suffered total brachial plexus avulsion injury, 2 cases were diagnosed with upper trunk partial injury and C_7T_1 nerve root completely avulsion, 2 cases were diagnosed with C_7T_1 nerve root completely avulsion and with normal upper trunk. Contralateral C_7 nerve root direct coapted with lower trunk in 56 cases and with media cord in 8 cases. In order to reduce the tension at the anastomosis site, humeral shorten osteotomy were performed in 30 cases, the length of the shorten bone ranged 2.6-5.8 cm, with the average of 3.9 cm. Results The following up period was 36 to 57 months, with the average 44 months. According to the standard of medical research council of the United Kingdom, the rate of muscle strength of finger, thumb wrist flexor and cubitalis grailis attained grade 4 were 64.1%(41/ 64), 53.1% (34/64), 73.4% (47/64) and 50% (32/64) respectively. Conclusion The direct anastomosis-standard of contralateral C_7 with lower trunk in patient with brachial plexus injury can remarkably improve the effect of reconstructing the function of finger and wrist flexion because it reduces one anastomosis site and decreases the distance of nerve regeneration compared with the traditional method.
