分娩性臂丛神经损伤的早期显微外科治疗

目的 探讨分娩性臂丛神经损伤的手术治疗时机与方法。方法 1997年10月～2001年4月对32例分娩性臂丛神经损伤进行早期显徽手术治疗，术时年龄3个月～2岁，平均10个月，6个月以内19例，大于6个月13例。手术方法：臂丛神经松解12例，臂丛神经瘤切除端端缝合或神经桥接移植7例，膈神经移植于上干前股或肌皮神经7例，肋间神经移植于肌皮神经(经神经移植)6例。神经松解及神经吻合均应用显微器械操作，用7／0或9／0无损伤缝合线缝合。结果 术后30例患儿获随访1-3年5个月，平均1．9年。疗效评定标准：肱二头肌肌力达4级以上为优14例；3级者为良9例12级以下者为差或无效7例。优良率为76．7％，其中年龄小于6个月的19例为84．2％(16／19)；大于6个月的11例为63．6％(7／11)。结论 分娩性臂丛神经损伤患儿，出生后3～6个月无明显屈肘功能恢复者即应行显微手术治疗，神经松解和神经吻合效果优于神经移植术，根据术中探查的具体情况选择恰当的术式是提高疗效的关键。

EARLY MICROSURGICAL TREATMENT OF UPPER OBSTETRICAL BRACHIAL PLEXUS INJURY

Objective To search for the operation timing and methods for obstetrical brachial plexus injury(OBPI). Methods Thirty two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis( n =12), coaptation after resection of the neuroma without function( n =7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve ( n =7) and intercostal nerves transfer to musculocutaneous nerve( n =6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. Results Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7%(23/30). The results of the children under 6 months were better than those over 6 months. Conclusion The microsurgical operation might be considered at the age of 3 6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.