健侧C7椎体前移位联合多组神经移位治疗全臂丛神经根性撕脱伤

目的：探讨健侧C7神经根椎体前移位并联合多组神经移位治疗全臂丛神经根性撕脱伤的方法和疗效。方法对20例全臂丛根性撕脱伤患者采用健侧C7神经根、膈神经、副神经及健侧C7修复患侧下干后形成新的动力神经：臂内侧皮神经、前臂内侧皮神经、下干后股移位修复患侧下干、肌皮神经、肩胛上神经、腋神经、桡神经、正中神经内侧头。并进行长期随访，观察肩外展、屈肘、屈指和伸腕伸指及手部感觉功能恢复的情况。结果20例中有17例获得随访，随访时间20～72个月（平均38个月）。肩外展平均39°，有效率（肌力M2以上）71%，优良率（肌力在M3以上）59％；屈肘平均77°，有效率83%，优良率53％；屈指、屈拇功能恢复：10例指屈肌力≥M2，有效率为59%（10/17），其中7例肌力≥M3，优良率为42%；伸肘恢复有效率（肌力M2以上）59%，优良率42%；伸指有效率47%，优良率36%。结论健侧C7神经根椎体前移位并联合多组神经移位治疗全臂丛神经根性撕脱伤是有效的治疗方法之一。

Contralateral C7 nerve transfer via anterior vertebral path combined with multiple donor nerves transfer for the treatment of brachial plexus total roots avulsion

Objective To report the method and outcome of contralateral C7 nerve transfer via anterior vertebral path combined with multiple donor nerves transfer for the treatment of brachial plexus total roots avulsion. Methods Using contralateral C7 nerve, phrenic nerve, accessory nerve and new donor nerves such as medial brachial cutaneous nerve, medial antebrachial cutaneous nerve and posterior division of lower trunk formed by contralateral C7 nerve repaired the injured lower trunk of 20 cases. Results After 20-72 months follow-up of 17 cases in totally 20, the average angle of shoulder abduction was 39° , efficiency （muscle strength reached M2） rate was 71%, excellent（muscle strength reached M3） rate was 59%. The average angle of elbow flexion was 77° , efficiency rate was 83%, excellent rate was 53%. The efficiency rate of finger and thumb flexion was 59%（10/17）, excellent rate was 42%, the efficiency rate of elbow extension was 59%, excellent rate was 42%. The efficiency rate of finger extension was 47%, excellent rate was 36%. Conclusion The treatment of brachial plexus total roots avulsion by contralateral C7 nerve transfer via anterior vertebral path combined with multiple donor nerves transfer is an effective method.