同侧C_7神经根移位后对其支配肌影响的初步观察

目的　观察C7神经移位后对C7神经根所支配肌肉功能的影响。方法　 1996年 2月至 2 0 0 0年 2月 ,对 7例臂丛上干或C5,6神经根损伤患者 ,均采用同侧C7神经根 (全部 )移位修复 ;并观察手术前、后背阔肌、肱三头肌及指总伸肌肌力及肌电的变化。术后 1周 7例 ,术后 4个月 6例 ,术后 1年 5例进行了肌力测定及肌电检查。结果　术后 1周背阔肌、肱三头肌及指总伸肌的肌力较术前均有所下降 ,下降幅度多在 1级以内。肌力的下降均呈可逆性 ,术后 4个月三块肌肉的肌力均已恢复正常。术后 3个时间组三块肌肉CMAP(复合肌肉动作电位 )的波幅、潜伏期和术前比无明显影响。结论　臂丛上干损伤采用同侧C7移位后 ,供区背阔肌肌力下降最明显 ,肱三头肌次之 ,指总伸肌最小。     

同侧C7神经根移位后对其支配肌影响的初步观察

目的：观察C7神经移位后对C7神经根所支配肌肉功能的影响。方法：1996年2月至2000年2月,对7例臂丛上干或C5,6神经根损伤患者,均采用同侧C7神经根（全部）移位修复,并观测手术前、后背阔肌、肱三头肌及指总伸肌肌力及肌电的变化。术后1周7例,术后4个月6例,术后1年5例进行了肌力测定及肌电检查。结果：术后1周背阔肌、肱三头肌及指总伸肌的肌力较术前均有所下降,下降幅度多在1级以内。肌力的下降均呈可逆性,术后4个月三块肌肉的肌力均已恢复正常。术后3个时间组三块肌肉CMAP(复合肌肉动作电位）的波幅、潜伏期和术前比无明显影响。结论：臂丛上干损伤采用同侧C7移位后,供区背阔肌肌力下降最明显,肱三头肌次之,指总伸肌最小。     

背阔肌电生理支配权重分析在同侧C7神经根移位术中的临床意义

目的 通过比较健侧G移位术中背阔肌上、中、下份复合肌肉动作电位（compound muscle action potential，CMAP）波幅的差异，了解臂丛神经根对背阔肌的支配权重，从而为同侧G移位术的应用提供电生理依据。方法于健侧G移位术中依次刺激臂丛神经上、中、下干，分别于背阔肌上、中、下份记录CMAP，比较CMAP波幅差异，确定各臂丛神经对背阔肌的支配权重。术后4周随访背阔肌肌力。结果CMAP波幅提示背阔肌上份主要受臂丛中干和上中干支配占60％，受上干支配仅10％；中份受中干支配占70％，受上干支配占15％；下份受中、下干和中干支配占70％，无单独上干支配。综合背阔肌上中下份分析显示由上干主要支配仅占8％、由中干主要支配占33％、由下干主要支配占10％、中下干支配占23％、上中下干支配占8％。术后4周随访背阔肌功能无明显影响。结论通过术中对背阔肌所受臂丛神经支配的电生理权重的研究，证实了同侧G神经根移位术的安全性。     

不同术式切断C7神经根后对神经支配肌影响的实验研究

目的　研究切断大鼠 C7神经根不同纤维束组后其支配肌的肌电图变化 ,为临床选择性 C7神经根移位术提供理论根据。方法　 SD大鼠 2 4只 ,按手术术式不同随机分成 3组 ,每组 8只鼠。A组 :单纯切断上干 ;B组 :切断上干及部分中干 ( C7前股前外侧部分 ) ;C组 :切断上干及全中干。左侧为实验侧 ,右侧为自身正常对照组。术后 4周 ,各组大鼠测定双侧背阔肌、肱三头肌、指总伸肌的复合肌肉动作电位 ( CMAP) ,并计算其潜伏期和波幅。所得数据进行统计学处理。结果　与对照组相比 ,C组背阔肌、肱三头肌及指总伸肌 CMAP的波幅及潜伏期均有明显的变化 ,波幅衰减、潜伏期延长 ;以背阔肌受的影响最为显著。A、B两组上述肌肉 CMAP的波幅及潜伏期均无明显改变。结论　单纯上干损伤后切取 C7神经根前股前外侧束组对 C7神经根主要支配肌 (背阔肌、肱三头肌、指总伸肌 )并无多大影响 ;而 C7全干切断后对上述肌肉影响较大     

肱三头肌及指总伸肌电生理支配权重分析在同侧C7神经根移位术中的临床意义

目的 分析在健侧C7神经根移位术中得出的臂丛神经各干对肱三头肌/指总伸肌的电生理支配权重,推断其对于同侧C7神经根移位术的影响,为探讨其安全性和适应证提供电生理依据.方法 随机选择2007年8月-2007年10月15例全臂丛神经根性撕脱伤,行健侧C7神经根移位的患者.男13例,女2例:年龄18～49岁,平均28岁.致伤原因:坠落伤1例,压砸伤2例,余均为车祸伤.左侧8例,右侧7例.术中依次刺激健侧臂丛神经上、中、下干,于肱三头肌/指总伸肌记录复合肌肉动作电位(compound muscle action potential,CMAP),比较各干的CMAP波幅所占百分比,确定臂丛神经各干对肱三头肌,指总伸肌的电生理支配权重.术后6个月内随访肱三头肌/指总伸肌肌力,并复查肌电图了解其自发电活动和主动募集反应情况.结果 15例患者均获随访6个月.肱三头肌的电生理支配权重:上中干型3例(20%),中下干型3例(20%),全干型7例(47%),中干型2例(13%);指总伸肌:中下干型3例(20%),全干型10例(67%),下干型2例(13%).肱三头肌:术后1个月,2例出现肱三头肌肌力4级,募集反应单纯相,至术后3个月恢复正常.余患者术后1个月肌力均达5级,募集反应单纯混合相或混合相.指总伸肌:术后1个月,患者肌力及募集反应均恢复正常.结论 对于各种电生理支配权重的患者,C7神经根的切取均不会造成肱三头肌和指总伸肌的实质性损害,同侧C7神经根移位术是安全可行的;但对于中干支配权重高的患者,采用同侧C7神经根全干移位应慎重,有可能造成肱三头肌短期内的肌力下降.     

同侧颈7神经根移位治疗臂丛上干根性撕脱伤患肢功能变化的实验研究

目的研究臂丛上干根性撕脱伤再切取同侧颈，后不造成肢体功能进一步损害的代偿机制。方法60只SD大鼠随机等分为二组，上干根性撕脱＋同侧颈7神经根切断为实验组，单纯上干根性撕脱为对照组。术后3、6和12周每组取10只大鼠对颈7神经根代表肌（背阔肌、肱三头肌、桡侧腕短伸肌和指总伸肌）作肌肉组织学、神经电生理与运动终板组织形态学的检测。结果术后3周实验组与对照组相比，四块颈7代表肌的湿重显著减轻且肌细胞截面积缩小，复合肌肉动作电位（CMAP）的潜伏期显著延长并波幅明显下降，运动终板突触后膜面积明显减小，上述指标的二组差异均有统计学意义（P〈0．05或P〈0．01）。荧光显微镜观察显示实验组颈7代表肌的运动终板分布稀疏，电镜下可见形态不成熟的再生运动终板。伤后6周，实验组肱三头肌CMAP潜伏期及波幅的恢复率以及桡侧腕短伸肌与指总伸肌肌细胞截面积、CMAP潜伏期及波幅和突触后膜面积的恢复率与对照组相比，差异无统计学意义（P均〉0．05）。实验组颈7代表肌的运动终板数量已较3周时明显增多，超微形态亦趋于成熟。到12周，实验组各项检测指标的恢复率均已接近对照组（P均〉0．05），其颈7代表肌的运动终板分布密集且数量较多，超微结构接近成熟，形态与对照组基本一致。结论臂丛上干根性撕脱伤切取同侧颈7神经根后，下干神经纤维能通过末梢运动终板的再生对中干代表肌进行代偿性支配，故不会导致肢体功能的进一步损害。     

臂丛颈7神经根支配主要代表肌的电生理研究

目的 通过电生理检测分析臂丛颈,神经根的主要代表肌.方法 选择16例臂丛神经根性撕脱伤行健侧颈7神经根移位的患者,术中采用电生理检测,对颈7神经根支配肌的波幅进行分析,确定颈7神经根的主要代表肌.结果 电生理检测表明背阔肌与肱三头肌长头均可较好地代表颈7神经根的功能.尤其是肱三头肌长头在所有16例患者的检测中,刺激颈7神经根所得复合肌肉动作电位(CMAP)波幅值均明显大于其余神经根所得波幅值;而背阔肌有4例(占25.0%),在刺激颈6神经根时所得CMAP波幅值与颈,神经根接近.结论 将肱三头肌长头、背阔肌作为定位颈,神经根的代表肌更具有合理性与科学性.     

C_7神经根移位治疗臂丛损伤术中胸背神经电生理检测的意义

目的探讨术中肌电生理检测对预测C7神经根移位术中胸背神经损伤程度的价值。方法7例全臂丛神经根性撕脱伤患者,均行健侧C7神经根移位术,术中切断C7之前分别刺激健侧臂丛上、中、下干,以及C7神经根各束支,采用肌电仪记录背阔肌动作电位波幅(Amp),了解各神经对背阔肌的支配权重。结果干部刺激后,背阔肌复合肌肉动作电位Amp在上、中、下干分别为(2.26±1.17)mv,(3.47±1.48)mv及(2.67±1.21)mv,中干与上、下干之间均存在统计学差异(P<0.05),而C7各股束支中,后股总体Amp为(4.14±1.94)mv,明显高于前股(2.08±1.24)mv(P<0.01),且后股内侧Amp最大,为(3.97±1.53)mv,大于后股外侧(2.87±1.41)mv(P<0.05)。背阔肌支配权重在臂丛干部,以中干(41.30%±2.56%)为大,而中干又以中干后股(66.90%±1.72%)、后股内侧(38.37%±1.65%)为大。结论术中电生理检测可以较精确定位背阔肌的支配神经来源,对合理选择C7神经根移位术式、提高C7神经根移位术式安全性具有重要的临床指导意义。     

同侧颈7移位修复臂丛上干不全损伤的疗效与背阔肌功能的关系

目的：分析用同侧颈7移位治疗臂丛上干不全损伤的疗效与背阔肌功能的关系，方法：1997例3月至2000年9月，对9例臂丛神经上干损伤或上，中干不全损伤伴膈神经损伤患者采用同侧颈7移位于上干前股以恢复屈肘功能，术前检查伤侧背阔肌肌力，并在术后分析疗效时观察同侧颈7移位与背阔肌肌力的关系。结果：6例术前背阔肌肌力正常者作同侧颈7移位于上干前股后，伤侧屈肘功能均得到恢复，3例术前背阔肌肌力减退或肌力消失者，术后屈肘功能均未恢复。结论：臂丛神经上，中干不全损伤时如伤侧背阔肌肌力减退或肌力消失时，不应选择同侧颈7作动力神经。     

颈7神经根切断术后的肌电电生理改变（II）

为进一步研究颈７神经根切断后对上肢神经功能的早期影响，近年来我们对１８例应用健侧颈７神经根移位桥接治疗的臂丛神经损伤患者，于同一个体相同检测条件下测定并观察切断颈７神经根术前、术后２周内，健侧上肢的肌电电生理变化。观察内容及结果１．肌电：背阔肌、肱三头肌、伸指总肌和尺侧屈腕肌，术后均无明显失神经改变。２．周围神经传导：（１）五个手指指神经的腕感觉神经动作电位（ＳＮＡＰ），术后１￣３指ＳＮＡＰ波幅均     

Functional compensative mechanism of upper limb with root avulsion of C5-C6 of brachial plexus after ipsilateral C7 transfer

Objective： To investigate the compensative mechanism of no further impairment of the upper limb after ipsilateral C7 transfer for treatment of root avulsion of C5-C6 of the brachial plexus.
Methods： Sixty Sprague Dawley （SD） rats were randomly divided into a CT-transection group and a control group, 30 rats each. In the CT-transection group, the left forelimbs of the animals underwent transection of ipsilateral C7 nerve root while C5 and C6 nerve roots were avulsed. In the control group, the left forelimbs only underwent C5 and C6 root avulsion. The representative muscles of C7 （innervated mainly by C7） including latissimus dorsi, triceps, extensor carpi radialis brevis and extensor digitorum communis were evaluated with neurophysiological investigation, muscular histology and motor end plate histomorphometry 3, 6 and 12 weeks after operation. The right forelimbs of all rats were taken as the control sides.
Results： Three weeks after operation, the recovery rates of amplitudes of compound muscle action potential （CMAP） and CMAP latency, muscular wet weight and cross-sec- tional area of muscle fibers, and area of postsynaptic membranes of those four representative muscles in the C7- transection group were significantly lower than those of the control group （P 〈0.05 or P 〈0.01）. Six weeks postoperatively, the recovery rates of CMAP amplitude and latency of the triceps showed no significant difference between the C7- transection group and the control group （P〉0.05）. For theextensor carpi radialis brevis and the extensor digitorum communis, the recovery rates of the cross-sectional area of muscle fibers, the amplitude and latency of CMAP and the area of postsynaptic membranes showed no significant dif- ference between the two groups （P 〉0.05）, while the rest parameters were still significantly different between the two group （P 〈0.05 or P 〈0.01）. As far as the ultramicrostructure was concerned in the CT-transection group, more motor end plates of four representative m     

Accessory nerve neurotization in infants with brachial plexus birth palsy

We report the surgical results of 13 accessory nerve neurotizations in brachial plexus birth palsy. The mean age at operation was 5.9 months. The accessory nerve was transferred to three C5 roots, to three C6 roots, to four posterior division of the middle trunks, to one musculocutaneous nerve, and to two suprascapular nerves. Sixty-seven percent of the cases acquired M4 or more in the deltoid muscle, 88% in the infraspinatus muscle, and 100% in the biceps brachii muscle. Twenty-five percent of the cases acquired M4 or more in the triceps brachii muscle and the wrist extensor muscles. These results were much better than formerly reported for adult cases by other authors. No functional compromise of the trapezius muscle was noted. The accessory nerve neurotization can be used safely and effectively in neurosurgical reconstruction of the brachial plexus palsy in infants. © 1994 Wiley-Liss, Inc.     

臂丛根性损伤两种神经电图—肌电图检测方法的诊断符合率

目的比较两种神经电图－肌电图检测方法对臂丛根性损伤的诊断符合率。方法１９９７年前，对８２例臂丛根性损伤用上肢五大神经代表肌肉及肩胛带肌群肌电图（ＥＭＧ）、复合肌肉动作电位（ＣＭＡＰ）、运动神经传导速度（ＭＮＣＶ）、感觉神经诱发电位和传导速度（ＳＮＡＰ、ＳＮＣＶ）及体感诱发电位（ＳＥＰ）进行分析诊断。１９９７年起，对１１８例臂丛根性损伤加测颈椎旁肌ＥＭＧ、双侧膈肌的ＣＭＡＰ和斜方肌的ＥＭＧ、ＣＭＡＰ进行诊断。结果１９９７年至今，臂丛根性损伤神经电图－肌电图的诊断和术中发现相比，诊断完全符合率为８０％，完全及基本符合率为９５．４％，比１９９７年前分别提高１４．１％和１０．３％。结论臂丛神经根性损伤加测椎旁肌ＥＭＧ、膈神经、副神经肌电可提高臂丛根性损伤尤其是Ｃ５节后损伤的肌电诊断正确率。     

Restoration of elbow function in severe brachial plexus paralysis via muscle transfers

SUMMARY: Reconstruction of elbow function in severe or late brachial plexus injuries represents a challenge to the reconstructive microsurgeons. The current sophisticated techniques of nerve reconstruction in combination with secondary local or free functional muscle transfers, may offer satisfactory outcome. Latissimus dorsi can be transferred as a pedicled or free muscle to restore elbow function. We present our experience with elbow reanimation in late cases of brachial plexus paralysis utilising latissimus dorsi muscle transfer. From 1998 to 2006 we operated 103 patients with brachial plexus paralysis. Amongst these patients, 21 were late cases and underwent latissimus dorsi muscle transfer for elbow reanimation. Ten patients had free latissimus dorsi transfer for elbow flexion. Free latissimus dorsi muscle was neurotised either directly via three intercostals in three patients or with a nerve transfer procedure using the contralateral seventh cervical nerve root in seven patients. Care was taken to maintain the proper tension to the muscle, which must hold the elbow in static flexion of about 120 degrees at the end of the procedure. Powerful elbow flexion (M4-M4+) or extension (M4) was obtained after the first 3 months in all patients who had an ipsilateral pedicled latissimus dorsi transfer. In the group of free muscle transfers, elbow flexion was seen after 6-8 months. After the initiation of muscle contraction, eight of the patients regained elbow flexion of M3-M4+. Latissimus dorsi muscle transfer is a reliable method for elbow reanimation. Appropriate postoperative management is also an important factor to obtain better outcome.