CAJ | 학술논문

目的观察采用多组神经移位术结合后期手功能重建恢复全臂丛神经撕脱伤患者主动拾物功能的疗效.方法 33例全臂丛神经撕脱伤患者,一期手术均采用多组神经移位术,即副神经移位修复肩胛上神经恢复肩外展,健侧C7神经经椎体前通路移位与患侧下干直接吻合重建屈指、屈腕功能,同时将下干发出的前臂内侧皮神经移位修复肌皮神经恢复屈肘功能,膈神经与下干后股直接吻合同时重建伸肘、伸指功能.术后选择肌力获得有效恢复(肩外展恢复到30°或以上,伸肘、伸指肌力达到3级或以上,屈肘、屈腕、屈指肌力达到4级或以上)的患者进行二期手功能重建恢复患手的主动抓握功能.主要包括腕关节固定术、拇外展功能重建及掌板紧缩术等.结果一期神经移位术后平均41±7.7(36～73)个月.10例患者的肌力恢复达到二期手功能重建的条件,其中8例已进行二期手功能重建.6例患者恢复了部分主动拾物功能,1例因爪形指纠正失败,另1例因腕融合术后伸指肌腱粘连致伸指功能丧失.结论新设计的多组神经移位术可同时恢复全臂丛撕脱伤患者的肩外展、屈肘、屈腕、屈指及伸肘、伸指的有效肌力,在此基础上通过后期手功能重建,可成功重建患侧上肢的部分主动拾物功能.
목적 관찰채용다조신경이위술결합후기수공능중건회복전비총신경시탈상환자주동습물공능적료효.방법 33례전비총신경시탈상환자,일기수술균채용다조신경이위술,즉부신경이위수복견갑상신경회복견외전,건측C7신경경추체전통로이위여환측하간직접문합중건굴지、굴완공능,동시장하간발출적전비내측피신경이위수복기피신경회복굴주공능,격신경여하간후고직접문합동시중건신주、신지공능.술후선택기력획득유효회복(견외전회복도30°혹이상,신주、신지기력체도3급혹이상,굴주、굴완、굴지기력체도4급혹이상)적환자진행이기수공능중건회복환수적주동조악공능.주요포괄완관절고정술、무외전공능중건급장판긴축술등.결과 일기신경이위술후평균41±7.7(36～73)개월.10례환자적기력회복체도이기수공능중건적조건,기중8례이진행이기수공능중건.6례환자회복료부분주동습물공능,1례인조형지규정실패,령1례인완융합술후신지기건점련치신지공능상실.결론 신설계적다조신경이위술가동시회복전비총시탈상환자적견외전、굴주、굴완、굴지급신주、신지적유효기력,재차기출상통과후기수공능중건,가성공중건환측상지적부분주동습물공능.
Objective To observe the outcomes of the modified multiple nerve transfer s combined with the late hand function reconstruction to restore the active pick-up function of the paralyzed upper extremity in patients with total brachial plexus avulsion injuries (TBPAI).Methods 33 patients suffered with TBPAI firstly underwent multiple nerve transfers,which including accessory nerve transfers to neurotize the suprascapular nerve to recover the shoulder abduction,contralateral C7 (CC7) nerve transfers via the modified pre-spinal route with direct coaptation to restore lower trunk function and the musculocutaneous nerve was also neurotized by the transferred CC7 nerve via a cutaneous nerve graft to restore the function of elbow flexion,as well as the phrenic nerve transfers to neurotize the posterior division of lower trunk to restore the function of elbow and finger extension.The patients with muscle recovery were selected to perform the hand function reconstruction at the second stage for restoring the active pick-up function.The patients were chosen as followcriterias:the degree of shoulder abduction attained 30°or more,the motor power of elbow,wrist,and finger flexion attained grade M4 or more,elbow and finger extension attained M3 or more.The methods of hand function reconstruction included wrist fusion and flexor carpal ulnaris opponensplasty,in addition to palmar capsulodesis of the metacarpophalangeal joint.Results The mean follow up was 41±7.7 (range,36-73 months) after the first procedure of multiple nerve transfers,the muscle strength of elbow and finger and wrist flexion attained M 4 as well as the elbow and finger extension achieved M3 or more in 10 patients,all of 10 patients achieved 40°-80°shoulder abduction.8 out of 10 patients had performed the second surgical procedure for hand functional reconstruction.6 of them had successfully recovered the active pick-up function.Conclusions The newly designed procedure of multiple nerve transfers could effectively restore the function of shoulder abduction,elbow,wrist,and finger flexion,as well as elbows and finger extension in patients with TBPAI,combined with the hand functional reconstruction,active pick-up function could be successfully reconstructed.