同侧颈7神经根选择性移位术治疗臂丛上干根性撕脱伤

目的 针对臂丛上干根性撕脱伤合并膈神经损伤病例,采用新的同侧颈_7神经根选择性束组移位方法,并证实其科学性、可行性与实用性,方法 自96年6月～99年2月,运用同侧颈_7神经根选择性束组移位术12例。其中臂丛上干撕脱伤10例,臂丛上干根性撕脱伤合并中干颈_7神经根部分损伤2例。全麻下行同侧选择性颈_7神经根前股前外侧份移位,直接与上干前股显微缝合。术后随访9例,并进行疗效评价。结果 7例颈_7神经根前股外侧份移位至上于前股有明显疗效,术后2月肌电检查证实有移位神经长入;术后4～7月即见肱二头肌恢复屈肘动作,而原颈_7神经根支配肌肉功能均无明显功能障碍。结论 同侧选择性颈_7神经根纤维束组移位不仅不影响颈_7神经根原有支配肌的运动功能,而且提供动力神经源,不失为一种新的切实可行的手术治疗方法。

Treat the brachial plexus upper trunk avulsion by ipsilateral selective C_7 transfer

Objective To treat the upper trunk avulsion in brachial plexus injury patients with a new method . ipsilateral selective C7 transfer, and to lerify the rationality, reliability and practicability of this method was verified as well. Materials and Methods Selective ipsilateral C7 transfer was carried out in 12 patients from June 1996 to February 1999. 10 cases were upper trunk avulsion, the rest two were left upper trunk avulsion combined with partial injury of the middle trunk. Selective transfer of the anteriolateral part of the anterior division to the anterior division of upper trunk was done under general anesthesia. 9 cases were followed up and elaluated. Results In these five cases, obvious effectiveness was observed in 7 cases of transfer of anteriolateral part of the C7 anterior division to the upper trunk. Electromyographic examination showed nerve regeneration in postoperative two month. Detectable elbow flexion by biceps contraction was found in 4 ? postoperative month. The function of the C7 innervating muscles was not jeopardized. Conclusion Selective ipsilateral C7 transfer led to restoration of the reinnervating muscle functions without affecting the function of C7 innervating muscles. therefore it was a practicable new surgical procedure.