CAJ | 학술논문

目的：报道利用椎管内残留神经根修复臂丛神经损伤10例的随访结果。方法2002年2月至2006年6月，我院收治的13例臂丛神经损伤患者，CTM显示：部分已损伤的神经根仍存在椎管内神经前后根；而探查锁骨上臂丛神经时，在椎孔外找不到相应的具正常结构的神经根近端。通过打开椎管将椎管内残留的神经根，用腓肠神经桥接进行神经修复。术后至少随访3年者10例，分别为 C54例，C5～63例，C61例，C71例，C8～T11例。结果10例均在其椎管内找到了具有正常结构的神经根近端，C5修复肩胛上神经和C5神经远端各1例，C5修复腋神经1例，C5修复正中神经内侧头1例，C6修复上干前股1例，C7修复内侧束1例，C5～6分别修复上干后股、肌皮神经1例，C5～6分别修复上干后股、上干前股1例，C5～6分别修复肩胛上神经、上干前股1例，C8～T1共同修复正中神经内侧头1例。术后随访45～68个月，平均54个月。10例修复神经所支配肌肉的肌力均达3～4级，且肩外展、屈肘活动自如，不须进行特别锻炼。结论通过椎管内壁丛神经探查，可将传统手术放弃的椎管内残留神经根找到打开椎管对损伤神经根的近端进行修复，这将为臂丛神经根性损伤的修复提供理想的动力神经源；且通过打开椎管依据臂丛神经的解剖结构进行修复，有利于臂丛神经治疗效果的提高。
목적：보도이용추관내잔류신경근수복비총신경손상10례적수방결과。방법2002년2월지2006년6월，아원수치적13례비총신경손상환자，CTM현시：부분이손상적신경근잉존재추관내신경전후근；이탐사쇄골상비총신경시，재추공외조불도상응적구정상결구적신경근근단。통과타개추관장추관내잔류적신경근，용비장신경교접진행신경수복。술후지소수방3년자10례，분별위 C54례，C5～63례，C61례，C71례，C8～T11례。결과10례균재기추관내조도료구유정상결구적신경근근단，C5수복견갑상신경화C5신경원단각1례，C5수복액신경1례，C5수복정중신경내측두1례，C6수복상간전고1례，C7수복내측속1례，C5～6분별수복상간후고、기피신경1례，C5～6분별수복상간후고、상간전고1례，C5～6분별수복견갑상신경、상간전고1례，C8～T1공동수복정중신경내측두1례。술후수방45～68개월，평균54개월。10례수복신경소지배기육적기력균체3～4급，차견외전、굴주활동자여，불수진행특별단련。결론통과추관내벽총신경탐사，가장전통수술방기적추관내잔류신경근조도타개추관대손상신경근적근단진행수복，저장위비총신경근성손상적수복제공이상적동력신경원；차통과타개추관의거비총신경적해부결구진행수복，유리우비총신경치료효과적제고。
Objective To report the follow-up results of 10 cases of intraspinal nerve root stump repair for brachial plexus injuries. Methods From February 2002 to June 2006, 13 patients with brachial plexus injuries were adopted. The computed tomographic myelography ( CTM ) showed there were still injured nerve roots in the anterior and posterior nerve roots. The supraclavicular brachial plexus was explored, but no corresponding proximal nerve roots with normal structures were found outside the vertebral foramen. The spinal canal was opened, and then the nerve root stumps within it were repaired by the sural nerve graft. All the patients were followed up postoperatively, and 10 of them were followed up for more than 3 years, including 4 cases of C5, 3 cases of C5-6, 1 case of C6, 1 case of C7 and 1 case of C8-T1. Results The proximal nerve roots with normal structures within the spinal canal were found in 10 cases. The nerve roots of C5 were used to repair the suprascapular nerve in 1 case, the distal C5 nerve root in 1 case, the axillary nerve in 1 case and the medial part of the median nerve in 1 case. The nerve roots of C6 were used to repair the anterior division of the superior trunk in 1 case. The nerve roots of C7 were used to repair the medial cord in 1 case. The nerve roots of C5 and C6 were used to repair the posterior division of the superior trunk and the musculocutaneous nerve respectively in 1 case. The nerve roots of C5 and C6 were used to repair the posterior division and the anterior division of the superior trunk respectively in 1 case. The nerve roots of C5 and C6 were used to repair the suprascapular nerve and the anterior division of the superior trunk respectively in 1 case. The nerve roots of C8 and T1 were used to repair the medial part of the median nerve together in 1 case. The average follow-up period was 54 months ( range;45-68 months ). The muscle strength innervated by the repair nerve was recovered to grade 3-4. The shoulder abduction and the elbow lfexion were lfexible, and special exercises were not necessary. Conclusions As to brachial plexus injuries with the nerve roots ruptured around the vertebral foramen and with the nerve roots ruptured outside the vertebral foramen but with low-quality proximal nerve roots or no reliable agreement due to the close location, the spinal canal should be opened in order to repair the injured proximal nerve roots. Hence, an ideal dynamic nerve source can be obtained for the repair of brachial plexus injuries. The repair should be performed based on the anatomical structure of the brachial plexus, and the treatment outcomes will be improved.