肌内效贴治疗对产伤性上干型臂丛神经损伤患儿运动功能发育的影响

目的:观察肌内效贴治疗对产伤性上干型臂丛神经损伤患儿运动功能发育的影响。方法:选取产伤性上干型臂丛神经损伤患儿20例,随机分成两组:对照组(n=10)进行感觉输入及常规康复训练,观察组(n=10)在对照组的基础上辅以肌内效贴治疗。治疗前和治疗6个月后对患儿进行下列评估:A、Mallet评分;B、臂丛功能综合评价;C、GMFM-A区评估;D、Peabody精细运动发育量表评估。结果:两组治疗后,A、B、C、D项评估结果均优于本组治疗前,差异均有显著性意义(P0.05)。两组治疗前,各项评估的组间差异均无显著性意义,治疗后,观察组A、B、C、D项评估结果均优于对照组,差异均有显著性意义(t=2.172,2.295,2.305,5.936;P=0.044,0.034,0.036,0.000)。结论:肌内效贴治疗可改善产伤性上干型臂丛神经损伤患儿上肢功能,并有助于患儿粗大、精细运动功能的发育。     

术中电刺激及肌电监测在手外科周围神经损伤 诊治中的应用价值

目的:探究术中电刺激及肌电监测在手外科周围神经损伤诊治中的应用价值。方法:选取2011年5月至2016年12月我院手外科收治的周围神经损伤患者35例,给予松解手术治疗,术中给予电刺激并且通过肌电图仪监测电刺激前后受损神经的复合肌肉动作电位(CMAP)的潜伏期及波幅变化,术后3个月随访记录临床疗效。结果:与电刺激前比较,臂丛神经损伤组及尺神经损伤组CMAP潜伏期明显缩短(P<0.05),臂丛神经损伤组、正中神经损伤组及桡神经损伤组CMAP波幅明显增加(P<0.05);术后3个月随访91.42%的患者受损神经功能得到恢复。结论:术中电刺激及肌电监测可有效提高手外科周围神经损伤的临床疗效,促进受损神经再生,利于功能恢复。     

闭合性腋神经损伤的神经肌电图评价

目的探讨闭合性腋神经损伤的神经肌电图诊断作用特点。方法选择1998-08/2005-12吉林大学中日联谊医院手外科收治腋神经损伤患者22例,采用肌电诱发电位仪,定性定位诊断腋神经损伤。结果纳入患者22例,均进入结果分析。①肌电图检测结果:臂丛神经上干支配肌群中,只有腋神经支配的三角肌有异常电生理改变,其他肌群均正常。22块三角肌有失神经电位者18例,异常率81.8%(18/22);22块三角肌运动单位电位减少17例,异常率77.3%(17/22)。②神经电图检测结果:潜伏期在正常范围13例,延长5例,消失4例,异常率40.9%(9/22);复合肌肉动作电位波幅消失4例,衰减18例,异常率100%(22/22)。完全损伤4例,不完全损伤18例,其中严重损伤2例。患侧腋神经的潜伏期为(1.27±1.16)ms,高于正常值0.6ms,差异显著(t=2.18,P<0.05);复合肌肉动作电位波幅为(10.17±1.96)mV,高于正常值(4.3±0.5)mV,差异非常显著(t=16.13,P<0.01)。结论神经肌电图检测是腋神经损伤早期定性、定位诊断的重要手段。     

肌内效贴对脑卒中患者肩关节半脱位后肩痛的疗效观察

目的:观察肌内效贴对脑卒中患者偏瘫侧肩关节半脱位后肩痛的疗效。方法:56例脑卒中肩关节半脱位后肩痛患者,按照随机数字表法分为治疗组与对照组(各28例),两组患者均实施常规康复治疗及宣教,治疗组在此基础上结合肌内效贴干预。分别于治疗前和治疗6周后通过X线测量法测量肩峰与肱骨头间距(AHI)、肩关节视觉模拟评分(VAS)疼痛、Fugl-Meyer上肢功能评分、肩痛侧腋神经及肌皮神经的运动神经传导测定,对两组治疗结果进行疗效评价。结果:治疗前,两组患者AHI值、VAS评分、Fugl-Meyer上肢功能评分无明显差异(P0.05),且检测所有患者肩痛侧腋神经(刺激部位:Erb点;记录部位:三角肌)及肌皮神经(刺激部位:Erb点;记录部位:肱二头肌)后发现两组中某些患者肌皮神经(30例,53.57%)、腋神经(31例,55.36%)波幅明显低于正常值,而潜伏期轻度延长或正常(提示轴索损伤)。两组治疗6周后,治疗组各项评分改善优于对照组(P0.05)且无不良事件发生。结论:在常规康复治疗的基础上,肌内效贴在脑卒中患者偏瘫侧肩关节半脱位后肩痛早期防治中,具有良好的疗效,其相应机制有待进一步研究。     

闭合性腋神经损伤的神经肌电图评价

目的探讨闭合性腋神经损伤的神经肌电图诊断作用特点。方法选择1998-08／2005-12吉林大学中日联谊医院手外科收治腋神经损伤患者22例，采用肌电诱发电位仪，定性定位诊断腋神经损伤。结果纳入患者22例，均进入结果分析。④肌电图检测结果：臂丛神经上干支配肌群中，只有腋神经支配的三角肌有异常电生理改变，其他肌群均正常。22块三角肌有失神经电位者18例，异常率81．8％（18／22）；22块三角肌运动单位电位减少17例，异常率77．3％（17／22）。②神经电图检测结果：潜伏期在正常范围13例，延长5例，消失4例，异常率40．9％（9／22）；复合肌肉动作电位波幅消失4例，衰减18例，异常率100％（22／22）。完全损伤4例，不完全损伤18例，其中严重损伤2例。患侧腋神经的潜伏期为（1．27&;#177;1．16）ms，高于正常值0．6ms，差异显著（t=2．18，P〈0．05）；复合肌肉动作电位波幅为（10．17&;#177;1．96）mV，高于正常值（4．3&;#177;0．5）mV，差异非常显著（t=16．13，P〈0．01）。结论神经肌电图检测是腋神经损伤早期定性、定位诊断的重要手段。     

臂丛上干或下干单独支配C7主要支配肌的电生理改变

目的：制备臂丛部分损伤后再将同侧C7切除模型．观察臂丛神经上干或下干单独存在时，臂丛C7神经主要支配肌背阔肌和肱三头肌的电生理改变。方法：实验于2003-06／2004-06在深圳市福田区医院中心实验室完成。将40只SD大鼠随机分4组，切除臂丛神经上干组（切除上干组），切除臂丛神经下干组（切除下干组），切除臂丛神经上中干组（切除上中干组），切除臂丛神经中下干组（切除中下干组），每组10只。术后2周、2个月分别检测C7主要支配的肱三头肌和背阔肌电生理状况，以健侧肢体作对照。结果：40只大鼠全部进入结果分析。①肱三头肌动作电位波幅恢复率：术后2周切除下干组、切除上中干组、切除中下干组均低于健侧（P〈0．05）；术后2个月均可恢复到健侧水平（P〉0．05）。②背阔肌动作电位波幅：术后2周切除上中干组、切除中下干组均低于健侧（P〈0．05）；术后2个月均可恢复到健侧水平（P〉0．05）。③肱三头肌动作电位潜伏期延迟率：术后2周切除上干组、切除下干组、切除上中干组、切除中下干组均高于健侧（P〉0.05）。④背阔肌动作电位潜伏期延迟率：术后2周切除上中干组、切除中下干组均高于健侧（P〈0．05）；术后2个月均可恢复到健侧水平（P〉0．05）。结论：各肌肉动作电位最大波幅在术后2周均明显下降，但术后2个月，各靶肌肉动作电位波幅都有不同程度的恢复，说明背阔肌与肱三头肌失去主要支配神经后，功能虽会明显下降．但经过代偿，由上干或下干单独支配，可以使C7主要支配的背阔肌、肱三头肌动作电位波幅基本恢复到正常水平。     

脑卒中后肩关节半脱位对偏瘫侧上肢周围神经电生理特征的影响

目的探讨脑卒中后肩关节半脱位对偏瘫侧上肢周围神经电生理参数的影响。方法纳入20例脑卒中伴肩关节半脱位的患者,分别对患者双上肢肩胛上神经、腋神经、肌皮神经、桡神经、正中神经、尺神经的运动神经传导及桡神经、正中神经、尺神经的感觉神经传导进行评估,并对偏瘫上肢冈上肌、三角肌、肱二头肌、伸指总肌、拇短展肌和小指展肌进行静息状态下针极肌电图检测;采用Brunnstrom分期对患者的上肢和手功能进行评估,并对患侧神经肌肉复合动作电位(CMAP)波幅的变化率与患者病程、年龄及上肢Brunnstrom分期进行相关性分析。结果与健侧相比,脑卒中后肩关节半脱位侧的肩胛上神经、腋神经、肌皮神经、桡神经、正中神经、尺神经CMAP波幅均显著降低(P<0.01),肩胛上神经和腋神经的潜伏期延长(P<0.05),肌皮神经、桡神经、正中神经和尺神经潜伏期双侧差异无统计学意义(P>0.05)。桡神经、正中神经和尺神经运动传导速度双侧无差异(P>0.05)。偏瘫侧腋神经、肩胛上神经、肌皮神经CMAP波幅变化率明显高于桡神经、正中神经和尺神经(P<0.05)。偏瘫侧桡神经、正中神经和尺神经的感觉神经动作电位(SNAP)较健侧降低(P<0.01),感觉传导速度双侧差异无统计学意义(P>0.05)。偏瘫侧SNAP波幅变化率由高到低依次为正中神经、桡神经和尺神经,但两两对比差异均无统计学意义(P>0.05),感觉神经传导速度变化率两两对比差异亦无统计学意义(P>0.05)。肩关节半脱位后上肢所检肌肉均存在不同程度的自发电位,偏瘫上肢近端出现率高于远端肢体,其中冈上肌自发电位出现率为61.54%,三角肌为84.62%,肱二头肌为69.23%,伸指总肌和拇短展肌为46.15%,小指展肌为30.77%。偏瘫侧CMAP变化率与患者病程、年龄及上肢Brunnstrom分期之间均无明显相关性(P>0.05)。结论脑卒中后肩关节半脱位可导致支配肩和上臂的周围神经损害程度大于支配前臂和手的神经,可能影响患者上肢功能的恢复。     

肌间沟臂丛阻滞效果的CT评价

目的：应用CT观察局麻药在臂丛鞘内的分布与扩散状况,评价肌间沟臂丛阻滞的临床效果。方法：70例拟行上肢手术的患者,随机分为非异感组（NPAR组）、神经刺激组（PNS组）二组,每组35例,评估感觉和运动神经的阻滞程度、手术过程中的麻醉效果,每组随机10例行CT检查,扫描范围自C3至T3平面,并行注药侧的冠、矢状面CT重组,测量臂丛三干周围局麻药的扩散范围。结果：局麻药局限性分布于臂丛鞘内,肌间沟水平为完整的鞘样结构,其以下有明显的分隔,局麻药的分布范围在臂丛上干、中干两组间无明显差异,下干PNS组高于NPAR组（P<0.05）;二组患者中腋神经、肌皮神经、正中神经、桡神经的感觉及运动评分差异均无统计学意义;前臂内侧皮神经的感觉评分和尺神经的感觉及运动评分NPAR组明显高于PNS组（P<0.05）。结论：臂丛鞘是一多腔结构,局麻药注射的位置和深度直接影响阻滞效果,偏向尺侧的手术采用PNS定位为佳。     

早期规范化电刺激疗法在臂丛神经损伤中的疗效观察

目的观察早期规范化电刺激疗法在臂丛神经损伤中的治疗效果。方法将臂丛神经损伤患儿随机分成两组,实验组采用规范化电疗刺激疗法,对照组按常规方法进行治疗,每天一次,20天为一疗程,共3个疗程。两组患儿均为保守治疗,以物理因子治疗即电刺激疗法为主,配合运动训练、手功能训练和营养神经药物等综合治疗。评估指标:(1)肌电图显示的神经传导速度、波幅、运动单位募集、收缩时间;(2)临床观察:如肌力、肌张力、肌肉萎缩(测量);(3)手功能评估;(4)显效时间:评估患儿治疗3个疗程后的效果。结果实验组四项评估指标明显比对照组好。结论规范化电刺激疗法对臂丛神经损伤患儿的治疗效果明显优于盲目、无序的电刺激疗法治疗效果。     

肌电图与神经传导速度对Graves病患者神经肌肉受损的评估

目的：应用肌电图和神经传导速度检查探讨Graves病神经肌肉受损的临床诊断意义。方法：于2000-05／2003-12选择汕头大学医学院第一附属医院内分泌专科门诊的Graves病患者46例为研究对象，行肌电图和神经传导速度检查；正常对照组31例为健康志愿者，31例行肌电图检查，30例行神经传导速度检查。肌电图检测：用同心圆针电极观察三角肌、股四头肌自发电位及募集形式，记录及分析小力收缩时每块肌肉20个运动单位电位平均时限及去多相波平均时限、波幅和多相波百分比。神经传导速度检测：用表面电极分别在腕部刺激正中神经和内踝胫后神经，于外展拇短肌及拇展肌用表面电极记录正中神经和胫后神经运动末端潜伏期和复合肌肉动作电位。用指环电极分别刺激拇指、中指和趾1，用表面电极于腕部及内踝记录测定感觉神经传导速度及波幅，包括正中神经（拇指-腕，中指-腕）和胫后神经（趾1-内踝）。并用超强电刺激在正中神经腕部及胫后神经踝部检测F波潜伏斯及出现率。结果：纳入受试对象77例，均进入结果分析。①Graves病组患者肌电图示小力收缩后时限缩短、波幅降低，大力收缩后其峰波幅降低。Graves病组胫后感觉神经复合肌肉动作电位波幅与正常对照组比较降低；正中感觉神经拇指-腕复合肌肉动作电位波幅降低；正中神经中指-腕感觉神经传导速度减慢；Graves病组正中神经F波潜伏期延长和异常出现率增加。键）416例Graves病患者有神经肌肉临床症状26例（56％），肌电图异常39例（85％）；神经传导速度异常41例（89％）；以肌电图异常判断神经传导速度异常敏感性为83％，特异性为87％；以神经传导速度异常判断肌电图异常敏感性为87％。特异性为83％。结论：两种方法对Graves病神经肌肉损伤诊断敏感性高于临床症状，对慢性甲状腺功能亢进性肌病诊断异常率、敏感性和特异性相近；肌电图主要对肌源性损害敏感，神经传导速度主要对神经源性损害敏感，具互补性。     

超声引导下与神经刺激器联合超声引导下腋路臂丛神经阻滞在下肘部位手术患者麻醉中应用比较

[目的]比较神经刺激器联合超声引导及单纯超声引导行腋路臂丛神经阻滞在下肘部位手术患者麻醉中的应用效果.[方法]60例下肘部手术患者,随机分为观察组和对照组,各30例.对照组给予超声引导下腋路臂丛神经阻滞方案,观察组则予以神经刺激器联合超声引导下腋路臂丛神经阻滞方案.比较两组受试者操作时间、相关神经阻滞的起效时间、神经阻滞持续时间及0.5 h内阻滞成功率、一次性穿刺成功率差异及相关并发症发生情况.[结果]观察组0.5 h内臂丛神经阻滞总成功率显著高于对照组(100.0%vs 86.7%),相关并发症发生率则显著低于对照组(6.7%vs 26.7%),且差异均有显著性(P均<0.05).观察组平均操作时间及桡神经、尺神经、正中神经、肌皮神经等阻滞起效时间均显著低于对照组,神经阻滞持续时间则明显长于对照组(P均<0.05);两组一次性穿刺成功率比较差异无显著性(P>0.05).[结论]对下肘部位手术患者予以神经刺激器联合超声引导下腋路臂丛神经阻滞方案,利于提高其定位准确性及臂丛神经阻滞成功率,对降低其手术相关并发症发生风险、延长其神经阻滞持续时间等具有积极影响.     

Kinematic differences between children with obstetric brachial plexus palsy and healthy controls while performing activities of daily living

BackgroundResidual shoulder dysfunction and deformity impacts on functional performance in children with obstetric brachial plexus palsy. Clinical understanding of upper limb dynamic movement patterns is difficult with observation alone. This case-control study describes the significant kinematic differences between children with obstetric brachial plexus palsy compared to typically developing children while performing tasks of the modified Mallet Scale.MethodsEleven children with obstetric brachial plexus palsy (mean 10 years, range 7–15 years, Narakas group I-III) and 10 typically developing children (mean 9 years 9 months, range 6–15 years) completed three-dimensional upper limb motion analysis using the acromion method to track dynamic scapular movement. Kinematic data were captured by a 4-CODA cx1 optoelectronic tracking system. Participants performed three trials of the modified Mallet scale tasks. Local coordinate systems, segment and joint rotations were defined as recommended by the International Society of Biomechanics.FindingsJoint rotation angles against time of the glenohumeral, thoracohumeral and scapulohumeral joints were calculated. Kinematic findings demonstrated increased internal rotation in all postures, reduced glenohumeral excursion, habitual “trumpet” posture of glenohumeral abduction/elevation and variability in movement strategies. Scapulohumeral rhythm during abduction task was 1.88:1 in typically developing children and 1.04:1 in children with obstetric brachial plexus palsy.InterpretationChildren with obstetric brachial plexus palsy demonstrate deficient external rotation in all tasks. Despite increased postural internal rotation, ability to move through internal rotation range is compromised. The glenohumeral joint showed the greatest range deficit, contributing to abnormal scapulohumeral rhythm. Future sub-group analysis of Narakas Classification is recommended.     

超声引导和传统解剖定位在臂丛神经阻滞的应用效果比较

目的比较超声引导和传统解剖定位行肌间沟联合腋路臂丛神经阻滞麻醉的临床效果。方法选择臂丛麻醉下行上肢手术的患者70例,随机均分为2组,各35例。对照组应用传统解剖定位下肌间沟联合腋路臂丛神经阻滞麻醉,观察组应用超声引导下肌间沟联合腋路臂丛神经阻滞麻醉,比较两组麻醉效果和不良反应。结果观察组患者在麻醉完成时间、起效时间比对照组短,观察组阻滞效果比对照组好,并发症发生率也更低,差异有统计学意义(P<0.05)。结论与传统解剖定位臂丛神经阻滞麻醉相比,超声引导定位臂丛神经阻滞麻醉具有操作简单,定位准确,可视下能够避开患者血管和周围重要组织,提高臂丛神经阻滞麻醉的安全性和成功率,减少麻醉不良反应及并发症,简单易学,增加患者的舒适性,具有较高的应用价值,值得临床推广应用。     

肌内效贴治疗“产瘫肩”畸形的随机对照临床研究

目的:随机对照研究使用肌内效贴治疗产瘫患儿"产瘫肩"畸形的疗效。方法:44例产瘫Narakas分型1~4型患儿随机分入肌内效贴组和常规治疗组各22例。2组均采用运动疗法,进行肌力和关节活动度训练。肌内效贴组还给予肌内效贴进行贴扎治疗。治疗前和治疗6个月时,对患儿的肩胛下角-躯干轴线夹角、盂肱夹角、Mallet评分和Gilbert分级进行评估。结果:治疗6个月后,肌内效贴组肩关节解剖结构得以改善,肩胛下角-躯干轴线之间夹角和盂肱夹角较治疗前明显改善(P<0.05),常规治疗组改善无统计学意义;与治疗前相比,2组Mallet评分和Gilbert分级提高均有统计学意义(P<0.05);肌内效贴组的Mallet评分差值大于常规治疗组(P<0.05)。结论:肌内效贴不仅能改善产瘫肩畸形,并且有助于提高肩关节功能。     

B超引导逆行锁骨下臂丛神经阻滞在急诊手术中的应用效果

目的探讨B超引导逆行锁骨下臂丛神经阻滞在急诊手术中的应用效果。方法将2018年1月至2018年12月于我院行急诊上肢手术的80例患者随机分为观察组和对照组,每组40例。观察组接受B超引导下行逆行锁骨下臂丛神经阻滞,对照组接受肌间沟臂丛神经阻滞。比较两组的麻醉效果。结果观察组的正中神经、尺神经、臂内侧皮神经、前臂内侧皮神经支配区域麻醉起效时间均短于对照组,差异具有统计学意义(P<0.05)。观察组的正中神经、尺神经、臂内侧皮神经、前臂内侧皮神经完全阻滞率均高于对照组,差异具有统计学意义(P<0.05)。结论B超引导逆行锁骨下臂丛神经阻滞的效果较肌间沟阻滞好,其起效时间快、阻滞完善,是适用于急诊手术的上肢麻醉方式。     

The natural history and management of brachial plexus birth palsy

Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs due to traction injury of the brachial plexus during childbirth. Approximately 20 % of children with brachial plexus birth palsy will have residual neurologic deficits. These permanent and significant impacts on upper limb function continue to spur interest in optimizing the management of a problem with a highly variable natural history. BPBP is generally diagnosed on clinical examination and does not typically require cross-sectional imaging. Physical examination is also the best modality to determine candidates for microsurgical reconstruction of the brachial plexus. The key finding on physical examination that determines need for microsurgery is recovery of antigravity elbow flexion by 3–6 months of age. When indicated, both microsurgery and secondary shoulder and elbow procedures are effective and can substantially improve functional outcomes. These procedures include nerve transfers and nerve grafting in infants and secondary procedures in children, such as botulinum toxin injection, shoulder tendon transfers, and humeral derotational osteotomy.     

Fascial manipulation as an adjunct to physiotherapy management in obstetric brachial plexus palsy: A case report

The integrity of connective tissue sheaths surrounding the nerves influences both the severity and the potential for recovery of brachial plexus lesions.This study presents an innovative, early onset, multidisciplinary approach to obstetric brachial plexus palsy. This approach is aimed at functional recovery of the nerve lesion and includes mobilization of the fascia using the Fascial Manipulation® method.This case study discusses how, in addition to conventional treatment, interventions aimed at the fascial system can potentially affect tension around the neural sheaths, enhance proprioceptive input and facilitate movement to influence obstetric brachial plexus palsy outcomes.     

Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis

Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be traumatic (gunshot wounds, lacerations, stretch/contusion and avulsion injuries) or non-traumatic in aetiology (supraclavicular brachial plexus nerve block, subclavian vein catheterisation, cardiac surgeries, or obstetric complications such as birth palsy). Despite the known association, the incidence and morbidity of a phrenic nerve injury and hemidiaphragmatic paralysis associated with traumatic brachial plexus stretch injuries remains ill-defined. The incidence of an associated phrenic nerve injury with brachial plexus trauma ranges from 10% to 20%; however, because unilateral diaphragmatic paralysis often presents without symptoms at rest, a high number of phrenic nerve injuries are likely to be overlooked in the setting of brachial plexus injury. A case report is presented of a unilateral phrenic nerve injury associated with brachial plexus stretch injury presenting with a recalcitrant left lower lobe pneumonia.     

Simultaneous Erb's and Klumpke's palsy: Case report

Mapping nerve deficits during a physical exam after trauma to the upper extremity can help determine not only if the brachial plexus was injured but also which nerve roots were involved. A 28-year-old male presented with simultaneous signs and symptoms of Erb's(C5) and Klumpke's(C8, T1) palsy, with sparing of the C6 and C7 roots. The patient presented several months ago to his local emergency room with shortness of breath, which was determined to be caused by left diaphragmatic paralysis through clinical and radiographical evidence. However, the etiology of the current nerve dysfunction in the upper extremity remained unknown. With persistent questioning and establishing the patient's trust in the caregivers, it was revealed that the patient had attempted suicidal hanging. We describe the clinical features and the likely mechanism of injury leading to this previously unreported combination of brachial plexus injuries. The unique injuries to this patient's brachial plexus can be explained by the sequence of events during the attempted suicidal hanging. The upper brachial plexus was injured during the initial moments where the neck was excessively stretched and the lower brachial plexus was injured due to the patient reaching up and holding himself by his arm for an extended period of time.     

臂丛神经的力学性质实验

背景:臂丛神经上干是新生儿分娩过程中臂丛神经损伤的好发部位。目的:对新鲜胎儿尸体臂丛神经上干进行拉伸实验、应力松弛实验以及蠕变实验,分析其拉伸力学性质和黏弹性力学性质。设计:随机对照实验,多变量分析。单位:吉林大学中日联谊医院放射线科,吉林大学南岭校区工程力学系。材料:实验标本为死亡的新鲜6.5～8月龄胎儿30具,男16具,女14具。方法:①常温解冻后取出臂丛神经上干,沿标本纵向切取100个试样,分别用于拉伸实验32个,应力松弛实验32个,蠕变实验32个,预实验4个。②拉伸实验、应力松弛实验、蠕变实验各自独立,均分为4组:男性6.5～7月胎龄组、男性8月以上胎龄组、女性6.5～7月胎龄组、女性8月以上胎龄组,各8个试样。③对臂丛神经上干进行单向拉伸实验,得出破坏载荷、强度极限、最大应变;对臂丛神经上干进行应力松弛实验和蠕变实验,得出应力松弛、蠕变实验数据和曲线。对实验数据进行归一化处理,得出归一化应力松弛函数、归一化蠕变函数及曲线。以一元线性回归分析的方法对实验数据进行回归分析,得出回归系数,拟合实验曲线。主要观察指标:臂丛神经上干的拉伸力学性质和黏弹性力学性质。结果:①6.5～7月龄胎儿臂丛神经上干的破坏载荷、强度极限、最大应变均小于8月龄以上胎儿(P<0.05)。男、女胎儿臂丛神经之间拉伸力学性质差异无显著性意义(P>0.05)。②女性8月以上胎龄组7200s蠕变量大于男性8月以上胎龄组[(10.2±1.1)%,(7.2±1.08)%,P<0.05]。女性6.5～7月胎龄组7200s蠕变量与男性6.5～7月胎龄组基本相近[(16.7±1.6)%,(15.1±1.2)%,P>0.05]。③男性8月以上胎龄组7200s应力松弛量与女性8月以上胎龄组基本相似(P>0.05)。男性6.5～7月胎龄组7200s应力松弛量大于女性6.5～7月胎龄组(P<0.05)。结论:分娩过程中相同外力作用下,只有少数抵抗外力能力差的胎儿会产生臂丛神经损伤,这种臂丛神经上干拉伸力学性质个体差异可能是由于遗传、营养不良等因素造成的。此外,在相同应力作用下男、女小月龄组的蠕变量均大于大月龄组,分析认为是由于小月龄胎儿臂纵神经发育不如大月龄胎儿成熟。