CAJ | 학술논문

背景:腋神经损伤后致三角肌麻痹,上肢外展功能受限,其手术治疗方案存在争议,采取后位入路的神经移位移植方法能否达到满意效果尚不明确.目的:探讨桡神经肱三头肌长头支移位移植至腋神经前支恢复肩外展功能的治疗方法.方法:选择吉林大学中日联谊医院手外科收治的13例腋神经损伤且无任何恢复征象的患者,男11例,女2例,年龄28.4(18～55)岁,三角肌肌力为M0或M1即三角肌功能完全丧失.采用后入路于10倍手术显微镜下将桡神经长头支移位移植至腋神经前支修复肩外展功能.采用中华医学会手外科学会上肢部分功能评定试用标准评定患者肩外展功能恢复结果.结果与结论:13例患者均获得随访,术后经21(6～53)个月随访,所有患者术后切口均一期愈合,未出现切口的术后感染及血肿,肩外展功能均有不同程度的恢复,其中三角肌恢复M4以上肌力7例,M3肌力4例,M2肌M1肌力各1例,有效率达92%,优良率达到85%,均末出现伸肘功能障碍.说明采用桡神经肱三头肌长头支移位移植修复腋神经前支恢复三角肌功能,是一种简便、可靠的修复肩外展功能的方法,且本术式适用于臂丛神经部分损伤、腋神经损伤及严重的四边孔综合征.
배경:액신경손상후치삼각기마비,상지외전공능수한,기수술치료방안존재쟁의,채취후위입로적신경이위이식방법능부체도만의효과상불명학.목적:탐토뇨신경굉삼두기장두지이위이식지액신경전지회복견외전공능적치료방법.방법:선택길림대학중일련의의원수외과수치적13례액신경손상차무임하회복정상적환자,남11례,녀2례,년령28.4(18～55)세,삼각기기력위M0혹M1즉삼각기공능완전상실.채용후입로우10배수술현미경하장뇨신경장두지이위이식지액신경전지수복견외전공능.채용중화의학회수외과학회상지부분공능평정시용표준평정환자견외전공능회복결과.결과여결론:13례환자균획득수방,술후경21(6～53)개월수방,소유환자술후절구균일기유합,미출현절구적술후감염급혈종,견외전공능균유불동정도적회복,기중삼각기회복M4이상기력7례,M3기력4례,M2기M1기력각1례,유효솔체92%,우량솔체도85%,균말출현신주공능장애.설명채용뇨신경굉삼두기장두지이위이식수복액신경전지회복삼각기공능,시일충간편、가고적수복견외전공능적방법,차본술식괄용우비총신경부분손상、액신경손상급엄중적사변공종합정.
BACKGROUND: Injury of axillary nerve leads to the inability of abduction in the upper limb which needs surgery treatment. However, which way of operative approach is more preferable is still uncertain. Whether one-stage posterior operation of nerve transfer can achieve better effects remains unclear, the choice of approach method is an argument.OBJECTIVE: To explore the therapeutic effect of the transposition operation of the branch to long head of triceps branchii to recover the anterior branch of axillary nerve that can restore the function of deltoid muscle and refrain from the deprivation of function to extend elbow.METHODS: A total of 13 cases with axillary nerve injury without any recovery sign admitted at the Department of Hand Surgery, China-Japan Union Hospital of Jilin University were selected, including 11 males and 2 females, aged 18-55 years, mean aged 28.4 years; Under 10-times operating microscope, the anterior branch of axillary nerve was chosen to coincide the branch to long head of triceps branchii in use of 11 -0 atraumatic nylon in posterior approach. The standard issued by the Hand Surgery Society of Chinese Medical Association was adopted to assess the upper limb function postoperatively.RESULTS AND CONCLUSION: All patients were followed-up for 6-53 months with an average of 21 months. All incisions after surgery gain primary healing. The function of shoulder abduction had recovered in some degree. Among of total, 7 cases had deltoid strength of M4 or even more; 4 cases had deltoid strength of M3; one had M2 and one had M1. The effective rate was 92%, and excellent rate was 85%. There was no impact on the extension of elbow in all cases. It was a reliable and convenient technique to recover shoulder abduction with the branch to long head of triceps brachii from radial nerve in restoration of the function of deltoid muscle. It was beneficial to the restoration of axillary nerve with partially injured brachial plexus, and severe quadril.