中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
9期
855-861
,共7页
王树锋%栗鹏程%薛云浩%李玉成
王樹鋒%慄鵬程%薛雲浩%李玉成
왕수봉%률붕정%설운호%리옥성
臂丛%创伤和损伤%膈神经%桡神经
臂叢%創傷和損傷%膈神經%橈神經
비총%창상화손상%격신경%뇨신경
Brachial plexus%Wounds and injuries%Phrenic nerve%Radial nerve
目的 观察膈神经移位修复下干后股重建臂丛神经撕脱伤伸肘、伸指、伸拇功能的效果.方法 2005年6月至2008年12月采用膈神经移位修复下干后股重建43例臂丛神经撕脱伤患者的伸肘及伸指功能,男36例,女7例;年龄4～44岁,平均(23.5±9.9)岁.受伤至手术时间1～12个月,平均(3.7±1.9)个月.其中全臂丛神经撕脱伤32例,中下干撕脱伴上干部分损伤或正常5例,C6～T1神经根撕脱伴C5椎孔外断裂或部分损伤6例.取锁骨上、下臂丛神经探查联合切口,显露下干后股,向近端干支分离后切断.将后侧束、桡神经向远端游离,切断后侧束的其他分支.将下干后股、后侧束及桡神经上提,膈神经在胸廓上口内切断,将膈神经与下干后股吻合.膈神经与下干后股直接吻合33例,通过腓肠神经桥接10例.结果 全部病例获得随访,随访时间36～73个月,平均(39.7±7.1)个月.伸肘、伸指、伸拇肌力达到3或以上的比例分别为81.6％、41.9％、39.5％.结论 膈神经移位修复下干后股,其伸肘功能恢复满意,伸指、伸拇功能的恢复仍需进一步改善.
目的 觀察膈神經移位脩複下榦後股重建臂叢神經撕脫傷伸肘、伸指、伸拇功能的效果.方法 2005年6月至2008年12月採用膈神經移位脩複下榦後股重建43例臂叢神經撕脫傷患者的伸肘及伸指功能,男36例,女7例;年齡4～44歲,平均(23.5±9.9)歲.受傷至手術時間1～12箇月,平均(3.7±1.9)箇月.其中全臂叢神經撕脫傷32例,中下榦撕脫伴上榦部分損傷或正常5例,C6～T1神經根撕脫伴C5椎孔外斷裂或部分損傷6例.取鎖骨上、下臂叢神經探查聯閤切口,顯露下榦後股,嚮近耑榦支分離後切斷.將後側束、橈神經嚮遠耑遊離,切斷後側束的其他分支.將下榦後股、後側束及橈神經上提,膈神經在胸廓上口內切斷,將膈神經與下榦後股吻閤.膈神經與下榦後股直接吻閤33例,通過腓腸神經橋接10例.結果 全部病例穫得隨訪,隨訪時間36～73箇月,平均(39.7±7.1)箇月.伸肘、伸指、伸拇肌力達到3或以上的比例分彆為81.6％、41.9％、39.5％.結論 膈神經移位脩複下榦後股,其伸肘功能恢複滿意,伸指、伸拇功能的恢複仍需進一步改善.
목적 관찰격신경이위수복하간후고중건비총신경시탈상신주、신지、신무공능적효과.방법 2005년6월지2008년12월채용격신경이위수복하간후고중건43례비총신경시탈상환자적신주급신지공능,남36례,녀7례;년령4～44세,평균(23.5±9.9)세.수상지수술시간1～12개월,평균(3.7±1.9)개월.기중전비총신경시탈상32례,중하간시탈반상간부분손상혹정상5례,C6～T1신경근시탈반C5추공외단렬혹부분손상6례.취쇄골상、하비총신경탐사연합절구,현로하간후고,향근단간지분리후절단.장후측속、뇨신경향원단유리,절단후측속적기타분지.장하간후고、후측속급뇨신경상제,격신경재흉곽상구내절단,장격신경여하간후고문합.격신경여하간후고직접문합33례,통과비장신경교접10례.결과 전부병례획득수방,수방시간36～73개월,평균(39.7±7.1)개월.신주、신지、신무기력체도3혹이상적비례분별위81.6％、41.9％、39.5％.결론 격신경이위수복하간후고,기신주공능회복만의,신지、신무공능적회복잉수진일보개선.
Objective To observe effect of phrenic nerve transter to the posterior division ot lower trunk (PDLT) for recovering elbow and finger extension in patients with brachial plexus root avulsion.Methods From June 2005 to December 2008,43 patients with brachial plexus root avulsion were treated with phrenic nerve transfer to PDLT to recover elbow and finger extension.There were 36 males and 7 females,aged from 4 to 44 years (average,23.5±9.9 years).The interval from injury to operation ranged from 1 to 12months (average,3.7±1.9 months).There were 32 cases of total nerve roots avulsion,5 cases of middle and lower trunk avulsion accompanied with upper trunk normal or partial injury,and 6 cases of C6 to T1 nerve root avulsion accompanied with C5 nerve root rupture or partial injury.The normal function of the phrenic nerve in the injured side should be proved preoperatively by radiographic and electromyographic examination.The entire brachial plexus in injured side was exposed through the combined incision.The posterior division of lower trunk was identified and severed as proximal as possible,and the posterior cord and radial nerve were dissociated distally until to the level of midpoint of humerus.Then the branches of the posterior cord except the radial nerve were sectioned.Direct anastomosis of the phrenic nerve and PDLT was performed in 33 patients,and indirect anastomosis through bridge grafting using sural nerve was performed in remaining 10 cases.Results All patients were followed up for 36 to 73 months (average,39.7±7.l months).The percentage of muscle strength ≥grade 3 in elbow,finger and thumb extension was 81.6％,41.9％ and 39.5％,respectively.Conclusion Satisfactory functional recovery of elbow extension had been achieved after the phrenic nerve transfer to the PDLT in patients with brachial nerve root avulsion injury,however,the functional recovery of finger and thumb extension was not as satisfactory as anticipated.
