神经移位修复臂丛神经根性撕脱伤

１９８７年７月～１９９４年６月，对２１例臂丛神经根性撕脱伤采用神经移位修复。其中复合移位４组神经（膈神经、副神经、颈丛运动支、肋间神经）者１例，３组（膈神经、副神经、颈丛运动支）者６例，２组（膈神经、副神经）者９例，１组（膈神经或颈丛运动支或肋间神经）者５例。术中发现臂丛神经变异１例，对４例合并锁骨下动脉损伤者，在神经移位的同时进行血管修复，促进患肢的血液循环，有利于神经的康复。随访到１９例，随访时间为８个月～６年２个月，优良率达７３．７％。认为，神经移位术是修复神经根性撕裂伤的常规方法，合并血管损伤者也应同时修复，对促进神经功能恢复有利     

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。     

神经移位治疗臂丛上干根性撕脱伤

目的 阐明神经移位治疗臂丛上干根性撕脱伤的疗效。方法 1990年3月至1998年2月,对14例臂丛干根性撕脱伤患者,将同侧胸前外侧神经直接移位于腑神经,胸背神经直接移位于肌皮神经,以重建三角肌、肱三头肌功能。结果 术后随访1年以上,三角肌肌力8例恢复至M4,4例M3,2例为M3－;肱二头肌肌力14例均恢复至M4。结论 运用同侧胸前外侧神经、胸背神经移闰的方法治疗臂丛上干根性撕脱伤,疗效较好;对原有的臂丛中、下干神经的主要功能无明显影响。     

Nerve Transfers for Traumatic Brachial Plexus Injury: Advantages and Problems

In recent years nerve transfers have been increasingly used to broaden reconstructive options for brachial plexus reconstruction. Nerve transfer is a procedure where an expendable nerve is connected to a more important nerve in order to reinnervate that nerve. This article outlines the experience of the Scottish National Brachial Plexus Injury Service as our use of nerve transfers has increased. Outcomes have improved for reconstruction of the paralysed shoulder using transfer of the accessory nerve to the suprascapular nerve. Medial pectoral to musculocutaneous nerve transfer has proved reliable for restoration of elbow flexion for patients with C5,6 and C5,6,7 injuries. Problems with nerve transfers include morbidity in the donor nerve territory, co-contraction, and pre-existing injury to the donor nerve. There is a balance of risks in these procedures which should be weighed up in individual cases.     

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.     

江西省级顾玉东院士工作站创伤性臂丛神经损伤流行病学特点及治疗方案分析

目的 分析江西省级顾玉东院士工作站创伤性臂丛神经损伤流行病学特点及治疗方案。方法 收集2018年1月至2021年12月江西省级顾玉东院士工作站诊治的全部新发创伤性臂丛神经损伤病例,建立标准的数据采集表,采集病人性别、年龄、致伤原因、诊断、手术方案等数据,分析4年间院士工作站创伤性臂丛神经损伤的流行病学特点。结果 全部符合条件的病人共58例,男47例,女11例,中位年龄43岁（8～78岁）。切割伤（29.31%）与交通事故伤（25.86%）为主要致伤原因。损伤部位以束支部多见（62.07%）,其次为根干部节后损伤（22.41%）、根性撕脱伤（12.07%）。治疗方案选择中,仅有10.34%的病人选择非手术治疗,手术治疗者中以单纯臂丛神经松解术最多（67.24%）,其次为神经移位术（18.97%）,神经移位术中以副神经移位修复肩外展功能最为多见。结论 江西省级顾玉东院士工作站创伤性臂丛神经损伤以中青年男性多见,交通事故伤与切割伤为主要致伤原因,大多数病人需要接受手术治疗。     

Nerve Transfers for Adult Traumatic Brachial Plexus Palsy (Brachial Plexus Nerve Transfer)

Adult traumatic brachial plexus injuries can have devastating effects on upper extremity function. Although neurolysis, nerve repair, and nerve grafting have been used to treat injuries to the plexus, nerve transfer makes use of an undamaged nerve to supply motor input over a relatively short distance to reinnervate a denervated muscle. A review of several recent innovations in nerve transfer surgery for brachial plexus injuries is illustrated with surgical cases performed at this institution. Approval obtained from Hospital for Special Surgery Institutional Review Board Level IV: series with no or a historical control group.