健侧C_7神经移位二例报道

健侧Ｃ７神经移位二例报道樊源冯光宙宋涛神经移位治疗全臂丛神经根性撕脱伤，现有的膈神经、副神经、肋间神经和颈丛等动力神经，作为供源尚显不足，不能满足修复患肢神经的需要。我们根据顾玉东（臂丛神经损伤与疾病的诊断．上海医科大学出版社，１９９２．４４～５２．...     

膈神经移位术治疗臂丛根性撕脱伤的护理

臂丛根性撕脱伤是骨科领域最严重的创伤之一，治疗复杂、疗效较差。1970年我国顾玉东首创膈神经移位术治疗臂丛神经根性损伤并取得良好疗效，此后膈神经移位术成为治疗臂丛损伤的。我科2005年以来对8例全臂丛撕脱伤患者行膈神经移位术经典术式，将其术前和术后的护理体会介绍如下。     

臂丛切割伤的特点及治疗

1997年以来,我院收治颈部切割伤致臂丛神经损伤9例,均系锐器切割颈部致臂丛神经上干或C5,6神经根损伤,多数病例神经损伤未得到一期修复.我们采用损伤神经探查直接缝合、神经移植或移位以及晚期功能重建手术等治疗,取得较满意的临床效果.     

臂丛切割伤的特点及治疗

2005年以来，我院收治颈部切割伤致臂丛神经损伤9例，均系锐器切割颈部致臂丛神经上干或C5,6神经根损伤，多数病例神经损伤未得到一期修复。我们采用损伤神经探查直接缝合，神经移植或移位以及晚期功能重建手术等治疗，取得较满意的临床效果。     

健侧C7神经根移位术的研究进展

全臂丛根性撕脱伤的治疗一直是一个棘手的难题，其治疗方式由最初单一的肋间神经、膈神经、副神经及颈丛神经移位等到后来的组合式神经移位，但施行这些神经移位术的病人中有25%～60.7%的病例[1]其患肢功能仍无任何改善。其中重要原因是再生轴突的供给不足。直到1989年顾玉东等首次报道健侧C7神经根移位术，其有效率达到70%，从而引起了国内外研究者的广泛关注。１基础研究１．１组化研究对神经干内的神经束性质的研究一直受到人们的重视。1964年Karnovsky与Roots提出用乙酰胆碱酯酶（AchE）法标识运动纤维，以区分功能束。AchE在神经节…     

《中华手外科杂志》2006年第22卷主题词索引

说明:(l)本索引按主题词汉语拼音顺序排列。(2)文题、作者后括号内数字为期号、最后为起止页。(3)因篇幅有限，每篇文题在本索引中仅在一个主题词条目中出现。B胃丛人工血管在臂丛神经合并血管损伤中应用的临床初步研究(彭峰，陈琳，蔡佩琴，等)(1):26一28健侧颈:神经根移位修复多条神经模型的建立及功能恢复动态观察(孙贵新，顾玉东，李继峰，等)(1):50一52神经移植术修复幼年大鼠臂丛神经损伤后对神经元保护作用的实验研究(傅阳，陈亮，顾玉东)(2):103一105创伤性臂丛神经损伤合并肩袖及肪二头肌长头膊损伤的超声诊断(劳杰，何继银，顾玉…     

健侧颈7神经移位与下干直接缝合治疗全臂丛根性撕脱伤4例报告

全臂丛神经根性撕脱伤患者的手功能重建一直是临床一大难题.1989年顾玉东等报道了健侧颈7神经移位术,为臂丛神经撕脱伤的修复提供了强大的动力神经源.目前健侧颈7移位修复正中神经,已成为重建全臂丛神经撕脱伤患者手功能的常用术式.但是,由于健侧颈7神经根较短,移位到对侧正中神经,需36cm的长段尺神经进行桥接,再生神经纤维除经过长途跋涉外,还要通过两个吻合口,其重建屈指功能的效果不理想.王树锋在应用解剖学研究的基础上,自2004年5月～8月为7例全臂丛神经撕脱伤患者成功地实施了健侧颈7神经经椎体前通路移位与患侧下干直接缝合术,我们从2004年10月开始进行同类手术4例,报道如下.……     

臂丛神经根性撕脱伤的治疗

神经移位术是治疗臂丛根性撕脱伤的主要方法。臂丛丛外移位神经包括肋间神经(Tsuyama1969)、副神经(Kotani1970)、颈丛运动支(Brunelli1977)、膈神经(顾玉东1970)、健侧颈7神经根(顾玉东1986)等。其中，健侧颈7根移位神经纤维数量最多，安全有效，已被国内外广泛应用。近年来，胸腔镜下超长切取膈神经，有效缩短了神经再生时间。对颈5、6根性撕脱伤，改良的Oberlin术式——臂丛丛内部分尺神经或正中神经移位修复肌皮神经肱二头肌支，手术简单，屈肘功能疗效肯定；同侧颈7根移位术有效且能恢复多组肌肉功能。对颈8胸1根性撕脱伤，肌皮神经肱肌肌支移位修复正中神经屈指肌束或骨间前神经以恢复屈指功能。对全臂丛根性撕脱伤，改良的Doi术式——双股薄肌移位联合神经移位较好恢复了手握持功能；肢体短缩，健侧颈7移位直接修复正中、尺神经，能恢复屈拇屈指功能，但手内肌功能仍无恢复。如何重建手内肌仍需作进一步探索。     

《中华骨科杂志》2004年第24卷主题词索引

(按汉语拼音字母顺序排列)A阿洪病老年环束带致自发性截指一例报告(徐德奎,王统海,胡永军)(1):10癌下肢慢性溃疡癌变骨侵蚀的X线诊断(金盛辉,刘海,潘小平,等)(7):390B白细胞计数脊柱化脓性骨髓炎的诊断及治疗(屠冠军,金明熙,朱悦,等)(6):355半月板,胫骨关节镜下可吸收性半月板箭治疗半月板损伤的初步报告(陈坚,吕厚山)(3):154臂丛臂丛上干长段缺损功能重建一例报告(陈亮,顾玉东,胡韶楠)(3):187 神经移植和移位术治疗早期分娩性臂丛神经麻痹(陈亮,顾玉东,胡韶楠,等)(8):449 健侧C7神经根经椎体前通路移位修复臂丛神经损伤疗效的初步观察(王…     

桡神经损伤手术治疗51例随访分析

桡神经损伤在临床上比较常见。致伤原因主要为肱骨骨折,肘关节脱位,上臂的切割伤、挤压伤、牵拉伤,还有手术误伤等,桡神经的主要功能是伸腕伸指伸拇,又以运动神经纤维为主。治疗效果较好;即使神经恢复不佳,肌腱移位亦可达到较满意的效果。我们对1993～1996年间采用手术治疗78例桡神经损伤病例进行随访,51例获随访结果,现作一临床分析。     

广州市五所医院臂丛神经损伤流行病学回顾性研究

目的通过对广州市五所医院臂丛神经损伤患者的流行病学调查，了解臂丛损伤的构成及其发病学特点。方法回顾性调查广州市五所医院近十年收治的452例臂丛损伤的病例。根据性别、年龄、损伤部位等，分析该群体的流行病学特征。结果20～39岁年龄组占64．6％，男女性别比为6：1。工人、农民工占62．4％，无业人员占11．7％。摩托车伤占45．1％，机动车辆伤占20．4％。损伤类型：全臂丛损伤占33．6％，上中干损伤占17．3％，上干损伤占12．6％。臂丛损伤合并多发伤的占74．6％，其中头部外伤占多发伤的57．0％。结论臂丛损伤主要发生在青壮年男性，摩托车和机动车辆伤是臂丛损伤的主要原因；加强臂丛交通伤的预防医学，有助于减少臂丛损伤的发生率。     

Diagnosis and management of adult BPI: Results of first 50 cases

IntroductionCommonest cause of brachial plexus injury in adults is traction injury sustained in motorcycle accidents. This article reports the results of first 50 cases done in a tertiary referral center with a brief review of literature.Material and methodsFirst 50 patients (46 male; 4 female, age from 12 to 45 years) with post traumatic brachial plexus palsy were included. There were 30 upper plexus and 20 pan plexus injuries, 27 had preganglionic and 23 postganglionic injury. Neurolysis was done in 19 patients and various combination of nerve transfer in 31. Mean follow-up period was 13.98 months.Results– Over all shoulder abduction was good in 10 patients, fair in 32 and poor in 8. Elbow flexion was good in 19 patients, fair in 18 and poor in 13 patients.ConclusionThe upper plexus and partial injuries have a good outcome in a majority of cases, while the results in global palsy are far from satisfactory.     

Restoration of Elbow Flexion by Transfer of the Phrenic Nerve to Musculocutaneous Nerve after Brachial Plexus Injuries

Traumatic brachial plexus injuries are a devastating injury that results in partial or total denervation of the muscles of the upper extremity. Treatment options that include neurolysis, nerve grafting, or neurotization (nerve transfer) has become an important procedure in the restoration of function in patients with irreparable preganglionic lesions. Restoration of elbow flexion is the primary goal in treating patients with severe brachial plexus injuries. Nerve transfers are used when spinal roots are avulsed, and proximal stumps are not available. In the present study, we analyze the results obtained in 20 patients treated with phrenic–musculocutaneous nerve transfer to restore elbow flexion after brachial plexus injuries. A consecutive series of 25 adult patients (21 men and 4 women) with a brachial plexus traction/crush lesion were treated with phrenic–musculocutaneous nerve transfer, but only 20 patients (18 men and 2 women) were followed and evaluated for at least 2 years postoperatively. All patients had been referred from other institutions. At the initial evaluation, eight patients received a diagnosis of C5-6 brachial plexus nerve injury, and in the other 12 patients, a complete brachial plexus injury was identified. Reconstruction was undertaken if no clinical or electrical evidence of biceps muscle function was seen by 3 months post injury. Functional elbow flexion was obtained in the majority of cases by phrenic–musculocutaneous nerve transfer (14/20, 70%). At the final follow-up evaluation, elbow flexion strength was a Medical Research Council Grade 5 in two patients, Grade 4 in four patients, Grade 3 in eight patients, and Grade 2 or less in six patients. Transfer involving the phrenic nerve to restore elbow flexion seems to be an appropriate approach for the treatment of brachial plexus root avulsion. Traumatic brachial plexus injury is a devastating injury that result in partial or total denervation of the muscles of the upper extremity. Treatment options include neurolysis, nerve grafting, or neurotization (nerve transfer). Neurotization is the transfer of a functional but less important nerve to a denervated more important nerve. It has become an important procedure in the restoration of function in patients with irreparable preganglionic lesions. Restoration of elbow flexion is the primary goal in treating patients with severe brachial plexus injuries. Nerve transfers are used when spinal roots are avulsed, and proximal stumps are not available. Newer extraplexal sources include the ipsilateral phrenic nerve as reported by Gu et al. (Chin Med J 103:267–270, 1990) and contralateral C7 as reported by Gu et al. (J Hand Surg [Br] 17(B):518–521, 1992) and Songcharoen et al. (J Hand Surg [Am] 26(A):1058–1064, 2001). These nerve transfers have been introduced to expand on the limited donors. The phrenic nerve and its anatomic position directly within the surgical field makes it a tempting source for nerve transfer. Although not always, in cases of complete brachial plexus avulsion, the phrenic nerve is functioning as a result of its C3 and C4 major contributions. In the present study, we analyze the results obtained in 20 patients treated with phrenic–musculocutaneous nerve transfer to restore elbow flexion after brachial plexus injuries.     

Axillary Artery and Brachial Plexus Injuries due to Anterior Shoulder Dislocation

Abstract Axillary artery injury after shoulder dislocation, without an associated bone fracture is very rare. Vascular injuries associated with brachial plexus lesions range in incidence from 27% to 44%. Management of axillary artery injury is mainly surgical and depends on the extent and the site of injury. The treatment of associated nerve injuries is more controversial. There is a scarcity of literature surrounding the association of injury to the brachial plexus, axillary artery and to the shoulder. The authors report a case of axillary artery associated with a delayed brachial plexus palsy and review the literature with the aim to identify the clinical pattern of this condition and to evaluate the outcome of neuropraxia after blunt axillary artery injury associated with anterior shoulder dislocation.     

Axillary nerve neurotization with the anterior deltopectoral approach in brachial plexus injuries

Combined neurotization of both axillary and suprascapular nerves in shoulder reanimation has been widely accepted in brachial plexus injuries, and the functional outcome is much superior to single nerve transfer. This study describes the surgical anatomy for axillary nerve relative to the available donor nerves and emphasize the salient technical aspects of anterior deltopectoral approach in brachial plexus injuries. Fifteen patients with brachial plexus injury who had axillary nerve neurotizations were evaluated. Five patients had complete avulsion, 9 patients had C5, six patients had brachial plexus injury pattern, and one patient had combined axillary and suprascapular nerve injury. The long head of triceps branch was the donor in C5,6 injuries; nerve to brachialis in combined nerve injury and intercostals for C5‐T1 avulsion injuries. All these donors were identified through the anterior approach, and the nerve transfer was done. The recovery of deltoid was found excellent (M5) in C5,6 brachial plexus injuries with an average of 134.4° abduction at follow up of average 34.6 months. The shoulder recovery was good with 130° abduction in a case of combined axillary and suprascapular nerve injury. The deltoid recovery was good (M3) in C5‐T1 avulsion injuries patients with an average of 64° shoulder abduction at follow up of 35 months. We believe that anterior approach is simple and easy for all axillary nerve transfers in brachial plexus injuries. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.     

Diagnosis and surgery of brachial plexus injuries

The surgical outcome of traumatic injuries of the brachial plexus (BP) depends on the following parameters: 1) accurate preoperative diagnosis of cervical root avulsion; 2) time interval between injury and surgery; 3) delicate handling of the nerve tissue; and 4) postoperative physiologic training. This report is based on a 15-year experience in brachial plexus surgery and is supported on the grounds of two major studies. In a prospective study, the authors controlled for the reliability of preoperative radiologic diagnosis by myelo-CT and MRI scans for 40 patients, to evaluate the integrity of the intraspinal cervical roots after brachial plexus injury. Surgical inspection via a cervical hemilaminectomy proved the accuracy of 85 percent and 52 percent of CT myelography and MRI, respectively. Retrospective statistical analyses were carried out of the long-term surgical results of 54 patients with traumatic injuries of the BP who received a grafting procedure between cervical roots C5 or C6 and the musculocutaneous nerve. Patients operated on up to 6 months after trauma showed a better result than patients operated on later than 12 months after trauma (p<0.05). In contrast, grafting between cervical root C5 or C6 and the use of different sural-graft sizes to reconstruct the musculocutaneous nerve demonstrated no statistically significant difference in the final outcome.     

Quality of life of patients with traumatic brachial plexus injuries

BackgroundTraumatic brachial plexus injuries are devastating injuries with lifelong disability and pain. The objective of this paper was to determine the functional disability of adult patients with traumatic brachial plexus injuries.Patients and methodsA cross-sectional study was done to determine the functional disability of patients using the FIL-DASH (Filipino Disability of the Arm, Shoulder and Hand) and the BPI (Brief Pain Inventory) Severity Pain Score (Tagalog version) questionnaires to determine the functional disability and quality of life of patients with traumatic brachial plexus injuries. A regression analysis was done to determine the factors associated with the FIL-DASH score with the level of significance set at p < 0.05.ResultsA total of 126 adult patients with traumatic brachial plexus injuries were evaluated with a mean age of 30.1(standard deviation [SD], 9.1; range, 17-69). There were 123 males and three females. The mean quality of life (FIL-DASH Score) of the 126 patients was 45.6 (95% CI: 42.5 – 48.7), (SD, 17.4), (range, 2.5 – 89.2), the mean BPI Severity Pain Score was 16.1 (95% CI: 14.6-17.8; SD, 8.9; range, 0-36) among 126 patients. On multivariate analysis using the hierarchical method of model building, higher range of elbow flexion, lower Brief Pain Inventory Severity Score, and longer months from injury were found to be associated with a better FIL-DASH score.ConclusionThe study showed that elbow flexion recovery, pain and duration of the injury were significantly associated with the FIL-DASH scores.     

医源性颈部神经损伤的修复

为探讨颈部手术所致医源性神经损伤的原因、预防、诊断和治疗，分析１９９３年～１９９６年８例因颈部手术致神经损伤的原因、诊治及结果。其中副神经损伤５例，臂丛神经损伤３例，均行手术治疗，治疗方法包括：神经松解、神经吻合、神经移植和神经移位。随访１１个月～３年，平均２４．５个月。结果表明，疗效优２例，良５例，差１例，优良率为８７．５％。认为，颈部手术易损伤神经，高度责任心和精细的手术操作是预防的关键；一旦确诊颈部神经损伤，应尽早手术修复     

Injuries associated with serious brachial plexus involvement in polytrauma among patients requiring surgical repair

Background

Brachial plexus injury occurs in up to 5% of polytrauma cases involving motorcycle crashes and in approximately 4% of severe winter sports injuries. One of the conditions for the success of operative therapy is early detection, ideally within three months of injury. The aim of this study was to evaluate associated injuries in patients with severe brachial plexus injury and determine whether there is a characteristic concomitant injury (or injuries), the presence of which, in the polytrauma, could act as a marker for nerve structures involvement and whether there are differences in severity of polytrauma accompanying specific types of brachial plexus injury.

Methods

We evaluated retrospectively 84 surgical patients from our department, from 2008 to 2011, that had undergone brachial plexus reconstruction. For all, an injury severity scale (ISS) score and all major associated injuries were determined.

Results

72% of patients had an upper, 26% had a complete and only 2% had a lower brachial plexus palsy. The main cause was motorcycle crashes (60%) followed by car crashes (15%). The average ISS was 35.2 (SD = 23.3), although, values were significantly higher in cases involving a coma (59.3, SD = 11.0). The lower and complete plexus injuries were significantly associated with coma and fractures of the shoulder girdle and injuries of lower limbs, thoracic organs and head. Upper plexus injuries were associated with somewhat less severe injuries of the upper and lower extremities and less severe injuries of the spine.

Conclusion

Serious brachial plexus injury is usually accompanied by other severe injuries. It occurs in high-energy trauma and it can be stated that patients involved in motorcycle and car crashes with multiple fractures of the shoulder girdle are at high risk of nerve trauma. This is especially true for patients in a primary coma. Lower and complete brachial plexus injuries are associated with higher injury severity scale.     

Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury

Background

Nerve transfer is a valuable surgical technique in peripheral nerve reconstruction, especially in brachial plexus injuries. Phrenic nerve transfer for elbow flexion was proved to be one of the optimal procedures in the treatment of brachial plexus injuries in the study of Gu et al.

Objective

The aim of this study was to compare phrenic nerve transfers with and without nerve graft for elbow flexion after brachial plexus injury.

Methods

A retrospective review of 33 patients treated with phrenic nerve transfer for elbow flexion in posttraumatic global root avulsion brachial plexus injury was carried out. All the 33 patients were confirmed to have global root avulsion brachial plexus injury by preoperative and intraoperative electromyography (EMG), physical examination and especially by intraoperative exploration. There were two types of phrenic nerve transfers: type1 – the phrenic nerve to anterolateral bundle of anterior division of upper trunk (14 patients); type 2 – the phrenic nerve via nerve graft to anterolateral bundle of musculocutaneous nerve (19 patients). Motor function and EMG evaluation were performed at least 3 years after surgery.

Results

The efficiency of motor function in type 1 was 86%, while it was 84% in type 2. The two groups were not statistically different in terms of Medical Research Council (MRC) grade (p = 1.000) and EMG results (p = 1.000). There were seven patients with more than 4 month's delay of surgery, among whom only three patients regained biceps power to M3 strength or above (43%). A total of 26 patients had reconstruction done within 4 months, among whom 25 patients recovered to M3 strength or above (96%). There was a statistically significant difference of motor function between the delay of surgery within 4 months and more than 4 months (p = 0.008).

Conclusion

Phrenic nerve transfers with and without nerve graft for elbow flexion after brachial plexus injury had no significant difference for biceps reinnervation according to MRC grading and EMG. A delay of the surgery after the 4 months might imply a bad prognosis for the recovery of the function.