CAJ | 학술논문

目的探讨多组神经束支部移位重建C5或C5.6根性撕脱伤后的肩外展外旋、屈肘功能的疗效. 方法 2007年1月至2010年12月收治21例臂丛上干损伤患者,男15例,女6例；年龄17～58岁,平均31.5岁.其中C5根性撕脱伤6例,C5.6根性撕脱伤15例.受伤至手术时间为3～11个月,平均5.1个月.21例患者肩关节不能外展、外旋,其中15例合并屈肘功能丧失.行副神经至肩胛上神经、肱三头肌肌支至腋神经前支、尺神经部分束至肱二头肌肌支移位重建肩外展及屈肘功能. 结果 19例患者术后获15 ～30个月(平均19.6个月)随访.末次随访时肩外展恢复至40°～180°,平均92°；肩主动外旋为60°～120°,平均91°；冈上肌、冈下肌肌力恢复至M4级10例,M3级7例,M2级2例；三角肌肌力恢复至M4级11例,M3级6例,M2级2例.14例获随访且合并屈肘功能丧失的患者中,12例主动屈肘＞90°,2例为60°～ 90°.按照Narakas臂丛神经功能评定标准评定疗效:肩关节功能优9例,良7例,差3例,优良率为84.2％；肘关节功能优8例,良4例,差2例,优良率为85.7％.结论应用功能相近的多组神经束支部移位早期重建C5.6神经根性撕脱伤后的肩外展屈肘功能,具有手术创伤小、患肢功能恢复快且好等优点,是一种较理想的功能重建方法.
목적 탐토다조신경속지부이위중건C5혹C5.6근성시탈상후적견외전외선、굴주공능적료효. 방법 2007년1월지2010년12월수치21례비총상간손상환자,남15례,녀6례；년령17～58세,평균31.5세.기중C5근성시탈상6례,C5.6근성시탈상15례.수상지수술시간위3～11개월,평균5.1개월.21례환자견관절불능외전、외선,기중15례합병굴주공능상실.행부신경지견갑상신경、굉삼두기기지지액신경전지、척신경부분속지굉이두기기지이위중건견외전급굴주공능. 결과 19례환자술후획15 ～30개월(평균19.6개월)수방.말차수방시견외전회복지40°～180°,평균92°；견주동외선위60°～120°,평균91°；강상기、강하기기력회복지M4급10례,M3급7례,M2급2례；삼각기기력회복지M4급11례,M3급6례,M2급2례.14례획수방차합병굴주공능상실적환자중,12례주동굴주＞90°,2례위60°～ 90°.안조Narakas비총신경공능평정표준평정료효:견관절공능우9례,량7례,차3례,우량솔위84.2％；주관절공능우8례,량4례,차2례,우량솔위85.7％.결론 응용공능상근적다조신경속지부이위조기중건C5.6신경근성시탈상후적견외전굴주공능,구유수술창상소、환지공능회복쾌차호등우점,시일충교이상적공능중건방법.
Objective To explore the clinical outcomes of transfer of combined nerve fascicles to reconstruct the shoulder abduction and elbow flexion lost after C5 or C5-C6 avulsion of the brachial plexus.Methods Between January 2007 and December 2010,21 patients with upper avulsion of the brachial plexus were treated in our department.They were aged from 17 to 58 years,with an average of 31.5 years.There were 6 cases of C5 root avulsion and 15 cases of C5-C6 root avulsion.The time interval between the injury and the operation ranged from 3 to 11 months (average,5.1 months).All the 21 patients lost abduction and external rotation of the shoulder and 15 of them lost elbow flexion in addition.All the patients underwent transfer of the spinal accessory nerve to repair the suprascapular nerve,transfer of the nerve to the long head of the triceps to repair the anterior branch of the axillary nerve,and partial transfer of the ulnar nerve fascicle to repair the biceps motnr branch (in 15 cases). Results Two cases were lost to the follow-up and the other 19 patients obtained follow-ups for 15 to 30 months,with an average of 19.6 months.At the last follow-up,the shoulder abduction was recovered to a range from 40° to 180° (average,92°); the active external rotation of the shoulder was recovered to a range from 60° to 120° (average,91°); the muscle strength of the supraspinatus and the infraspinatus was recovered to M4 in 10 patients,to M3 in 7 patients and to M2 in 2 patients; the muscle strength of the deltoid was recovered to M4 in 11 patients,to M3 in 6 patients and to M2 in 2 patients.Of the 14 patients without the function of elbow flexion who had been followed up,12 had active elbow flexion ＞ 90° and 2 had active elbow flexion between 60° and 90°.According to the Narakas' s functional evaluation system for the brachial plexus,the shoulder function was rated as excellent in 9 cases,as good in 7 cases,and as poor in 3 cases,with a good to excellent rate of 84.2％.The elbow function was excellent in 8 cases,good in 4 cases and ponr in 2 cases,with a good to excellent rate of 85.7％. Conclusion Transfer of combined nerve fascicles with functional similarity to early reconstruct the shoulder abduction and elbow flexion following C5-C6 root avulsion of the brachial plexus is feasible and effective,because it results in limited operative invasion,and quick and sound functional recovery of the limb affected.