CAJ | 학술논문

目的研究臂丛神经根性撕脱伤患者膈神经端侧缝合移位术后呼吸功能的变化情况.方法 5例臂丛神经根性撕脱伤患者接受了膈神经端侧缝合移位至臂丛上干前股或肌皮神经,术后35个月通过肺功能、胸部动态透视及神经电生理检查呼吸功能及术侧膈肌的功能.结果术后所有患者用力呼气量(FVC)、1 s用力呼气量(FEV1)和肺总量(TCL)与术前水平相同,术后X线片及胸透显示术侧膈肌均未出现抬高或活动度下降,膈神经传导潜伏期平均延长2.9ms,动作电位波幅平均下降32.4％.此外,5例患者肱二头肌都获得了神经再支配,其中3例患者的肱二头肌肌力达到M3或M3以上.结论膈神经端侧缝合移位术恢复屈肘功能的同时呼吸功能不受影响,对于需要保留膈肌功能的患者是一种可供选择的替代方案.
목적 연구비총신경근성시탈상환자격신경단측봉합이위술후호흡공능적변화정황.방법 5례비총신경근성시탈상환자접수료격신경단측봉합이위지비총상간전고혹기피신경,술후35개월통과폐공능、흉부동태투시급신경전생리검사호흡공능급술측격기적공능.결과 술후소유환자용력호기량(FVC)、1 s용력호기량(FEV1)화폐총량(TCL)여술전수평상동,술후X선편급흉투현시술측격기균미출현태고혹활동도하강,격신경전도잠복기평균연장2.9ms,동작전위파폭평균하강32.4％.차외,5례환자굉이두기도획득료신경재지배,기중3례환자적굉이두기기력체도M3혹M3이상.결론 격신경단측봉합이위술회복굴주공능적동시호흡공능불수영향,대우수요보류격기공능적환자시일충가공선택적체대방안.
Objective To investigate changes in respiratory function of patients with brachial plexus avulsion injuries (BPAIs) after phrenic nerve transfer by end-to-side neurorrhaphy.Methods A series of 5 patients with BPAI underwent phrenic nerve transfer to anterior division of the upper trunk or to the musculocutaneous nerve by end-to-side neurorrhaphy to reconstruct elbow flexion.Pre-and post-operative pulmonary function tests,chest fluoroscopy and phrenic nerve conduction studies were performed to evaluate the respiratory function and function of diaphragm on the affected side.Results The forced vital capacity(FVC),forced expiratory volume in one second (FEV1) and total lung capacity (TLC) measured 35 months postoperatively were not significantly different from the preoperative pulmonary function measurements in all the patients.Chest X-ray and fluoroscopy showed neither elevation nor reduced movement of diaphragm on the operated side.Phrenic nerve conduction study revealed an average of 2.9 ms increase in latency and 32.4％ decrease in action potential amplitude when compared to preoperative values.In addition reinnervation of the biceps was successful in all the patients.Biceps muscle strength reached M3 or higher in 3 patients.Conclusion Phrenic nerve transfer by end-to-side neurorrhaphy can lead to functional biceps recovery without compromising pulmonary function.It can be an alternative procedure for patients whose diaphragm function needs to be preserved.