CAJ | 학술논문

[目的]臂丛神经上中干损伤的修复治疗中肘屈曲功能是最为重要的.在已有的几种恢复肘关节屈曲功能的神经转位手术中,部分尺神经转位肌皮神经的手术(Oberlin' s method)是最新的方法.本报告应用Oberlin' s手术治疗早期和晚期臂丛神经上中干损伤的初步经验.[方法]5例臂丛神经上中干损伤的患者采用了Oberlin's手术进行伤肢肘关节屈曲功能的恢复治疗.患者平均年龄28岁,随访6～15个月.早期手术2例,分别伤后6个月和8个月手术.晚期病例3例,分别于伤后12～18个月实施手术.术后持续性进行肱二头肌、肘关节屈曲肌力、手内肌握力、尺神经支配区感觉测试.[结果]所有病例都恢复了肘关节的屈曲功能,都有3级以上的肱二头肌肌力恢复.2例早期病例术后1周内出现肱二头肌主动收缩,肘关节主动屈曲功能正常恢复时间平均6个月,平均肌力恢复4+级.3例晚期病例术后平均3个月出现肱二头肌收缩,肘关节主动屈曲功能正常恢复时间平均10个月,平均肌力恢复3+级.3例术后出现尺神经支配区感觉减退,1个月后自动恢复.[结论]Oberlin' s手术是治疗臂丛神经上中干损伤,快速有效恢复肘关节主动屈曲功能的有效方式.
[목적]비총신경상중간손상적수복치료중주굴곡공능시최위중요적.재이유적궤충회복주관절굴곡공능적신경전위수술중,부분척신경전위기피신경적수술(Oberlin' s method)시최신적방법.본보고응용Oberlin' s수술치료조기화만기비총신경상중간손상적초보경험.[방법]5례비총신경상중간손상적환자채용료Oberlin's수술진행상지주관절굴곡공능적회복치료.환자평균년령28세,수방6～15개월.조기수술2례,분별상후6개월화8개월수술.만기병례3례,분별우상후12～18개월실시수술.술후지속성진행굉이두기、주관절굴곡기력、수내기악력、척신경지배구감각측시.[결과]소유병례도회복료주관절적굴곡공능,도유3급이상적굉이두기기력회복.2례조기병례술후1주내출현굉이두기주동수축,주관절주동굴곡공능정상회복시간평균6개월,평균기력회복4+급.3례만기병례술후평균3개월출현굉이두기수축,주관절주동굴곡공능정상회복시간평균10개월,평균기력회복3+급.3례술후출현척신경지배구감각감퇴,1개월후자동회복.[결론]Oberlin' s수술시치료비총신경상중간손상,쾌속유효회복주관절주동굴곡공능적유효방식.
[Objective]The purpose of this study was to describe mid report the result of the ulnar nerve transfer to biceps muscle to restore elbow flexion after acute and delayed upper brachial plexus injuries.[Methods]Two patients with acute brachial plexus injury (the time between the injury and the operation were six and eight months) and three patients with delayed brachial plexus injury(the time between the injury and the operation were from twevle to eighteen months) underwent nerve transfer using fascicles of the ulnar nerve to the motor branch of the biceis muscle. The average age of the patients was twenty eight and the mean follow-up periods were nine months after the surgery. Patients were evaluated with regard to reinnervation of the biceps, ulnar nerve function, elbow flexion strength, and grip strength.[Results]For the two acute patients, the first sign of biceps muscle contraction were observed within 1 week, the average time required for reinnervation of the biceps after nerve fascicle transfer was within six months. For the three delayed patients, the first sign of bicep muscle contraction was observed in about three month, and the average time required for reinnervation of the biceps was ten months.Hypoesthesia of the ulnar nerve was clinically abserved in three patients, but this symptom disappeared within month with no treatment.Compared with those delayed cases, the acute patients had faster and better recovery of their olbow flexion function.However, all patients achieved grade-3 or better elbow flexion strength according to the grading system of the Medical Research Council.[Conclusion]The author recommend this safe, simple and effective Oberlin procedure for brachial plexus injuries involving the C5、6 or C5~7 nerve roots.