CAJ | 학술논문

目的探讨健侧颈7神经根经椎体前通路移位修复全臂丛神经根性撕脱伤下干后,下干的分支即臂内侧皮神经、前臂内侧皮神经、下干后股作为动力神经的应用方法和疗效.方法当膈神经和副神经损伤时,健侧颈7神经根经椎体前通路移位修复下干后,应用患侧下干的前臂内侧皮神经修复肌皮神经,臂内侧皮神经修复肩胛上神经,下干后股移位修复正中神经外侧头.临床治疗全臂丛神经根性撕脱伤患者14例.结果术后12例获得24～65个月(平均35个月)的随访,肩外展平均39°,有效率(肌力M2以上)67％,优良率(肌力M3以上)58％；屈肘平均77°,有效率75％,优良率58％；屈指、屈拇功能恢复:7例屈指肌力≥M2,有效率为58％,其中5例肌力≥M3,优良率为42％.结论健侧颈7神经根椎体前移位修复下干后的前臂内侧皮神经、臂内侧皮神经、下干后股可作为动力神经源移位修复肩胛上神经、肌皮神经、正中神经外侧头.
목적 탐토건측경7신경근경추체전통로이위수복전비총신경근성시탈상하간후,하간적분지즉비내측피신경、전비내측피신경、하간후고작위동력신경적응용방법화료효.방법 당격신경화부신경손상시,건측경7신경근경추체전통로이위수복하간후,응용환측하간적전비내측피신경수복기피신경,비내측피신경수복견갑상신경,하간후고이위수복정중신경외측두.림상치료전비총신경근성시탈상환자14례.결과 술후12례획득24～65개월(평균35개월)적수방,견외전평균39°,유효솔(기력M2이상)67％,우량솔(기력M3이상)58％；굴주평균77°,유효솔75％,우량솔58％；굴지、굴무공능회복:7례굴지기력≥M2,유효솔위58％,기중5례기력≥M3,우량솔위42％.결론 건측경7신경근추체전이위수복하간후적전비내측피신경、비내측피신경、하간후고가작위동력신경원이위수복견갑상신경、기피신경、정중신경외측두.
Objective To explore the feasibility and effectiveness of using branches of the lower trunk on the affected side as donor nerves,i.e.medial brachial cutaneous nerve,medial antebrachial cutaneous nerve and posterior division of the lower trunk,after contralateral C7 nerve root transfer to the lower trunk via pre-vertebral route.Methods When the phrenic nerve and spinal accessory nerve were injured along with the brachial plexus,contralateral C7 nerve root was transferred to repair the lower trunk via pre-vertebral toute.Medial antebrachial cutaneous nerve of the affected side was again transferred to repair the musculocutaneous nerve,medial brachial cutaneous nerve transferred to repair the suprascapular nerve,posterior division of the lower trunk transferred to repair lateral head of the median nerve.A total of 14 cases of complete brachial plexus root avulsions were treated.Results Postoperatively 12 cases were follow-up for 24 to 65 months (mean,35 months).Average shoulder abduction reached 39°.Results in 67％ of the cases were considered effective (musele strength reached M2),and 58 ％ excellent (muscle strength reached M3).The average angle of elbow flexion was 77°,75％ rated effective and 58％ rated excellent.Finger and thumb flexion was restored to some extent.Finger flexor strength was ≥ M2 in 7 cases with an effective rate of 58 ％ and ≥ M3 in 5 cases with an excellent rate of 42％.Conclusion After being neurotized by the contralateral C7 nerve root via pre-vertebral route,branches of the lower trunk can be used as donor nerves to neurotize the musculocutaneous nerve,supraseapular nerve and lateral head of the median nerve.