同侧颈7神经根移位治疗臂丛上千根性撕脱伤的实验研究

目的 实验性比较同侧C7神经根全根移位与其他3种方法治疗臂丛上千根性撕脱伤的疗效.方法 120只SD大鼠建立上千根性撕脱伤模型后随机等分为4组,每组30只.(1)A组:同侧C7移位至上千+副神经至肩胛上神经;(2)B组:Oberlin手术(尺神经一束移位至肱二头肌支)+副神经至肩胛上神经+桡神经肱三头肌长头支至腋神经前支;(3)C组:膈神经移位至上千前股+副神经至肩胛上神经+颈丛运动支至上千后股;(4)D组:膈神经移位至上千前股+副神经至肩胛上神经,不作腋神经修复.术后3、6和12周每组取10只大鼠作Ochiai评分、Barth足错步试验、Terzis梳头试验及神经再生指标的榆测.结果 术后3周,A组3项行为学检测指标与3个对照组差异无统计学意义(P>0.017),腋神经电生理指标均显著优于3个对照组,其余各项腋神经及三角肌组织学指标均显著优于C组和D组,但与B组比较差异无统计学意义.A组除肌皮神经再生有髓神经纤维通过率显著优于C组外,其余肌皮神经及肱二头肌的电牛理与组织学检测指标与3个对照组比较差异无统计学意义.12周时,A组各项行为学观察、几乎全部腋神经和三角肌的电生理与组织学检测以及部分肌皮神经和肱二头肌的电生理与组织学检测指标均已显著优于3个对照组.结论 同侧C7神经根移位对治疗臂丛上千根性撕脱伤的实验性疗效显著.

An experimental study on outcome of ipsilateral C7 nerve root transfer to repair the root avulsion of the brachial plexus

Objective To experimentally compare the treatment outcome of the injured upper limb of the root avulsion of C5 and C6 of the brachial plexus repaired by ipsilateral C7 nerve root transfer and other three multiple nerve transfers.Methods One hundred and twenty SD rats of simulated C5 and C6 root avulsion randomly divided into 4 groups,and 30 each underwent various combined nerve transfers.Group A:the ipsilateral C7 root transferred to the upper trunk of brachial plexus and the spinal accessory nerve to the suprascapular nerve;Group B:partial fascicles of the ulnar nerve transferred to the biceps branch(Oberlin's procedure),the spinal accessory to the suprascapular and branches to the triceps long head to the axillary nerve:Group C:the phrenic transfefred to the musculocutaneous,cervical plexus motor branches to the lower trunk(axillary nerve)of brachial plexus and the spinal accessory nerve to the supraseapular nerve;Group D:the phrenic transferred to the museuloeutaneous and the spinal accessory nerve to the supraseapular nerve.Neurotization outcomes were evaluated at 3,6 and 12 weeks postoperatively by comparing changes of behavioral tests(Ochiai clinical scores,Barth Foot-fault test and Terzis grooming test),neurophysiological investigations and muscular histology.Results At 3 weeks after operation,no significant difference was found between Group A and other three control groups in the three behavioral evaluations.Neurophysiologic investigations of the axillary nerve showed that Group A was superior to the other three groups.Muscular histological outcome of the axillary nerve and deltoid muscle showed that Group A was superior to the Group C and D,while no significant differenee was found between Group A and B.Except that the thruput of regenerating medullated musculocutaneous nerve fibers of Group A was superior to Group C,neurophysiological and histological outcome of the musculocutaneous nerve and biceps showed that no significant difference was found between Group A and other three groups.At 12 weeks postoperatively,nearly all the behavioral,neurophysiological and histological determination showed that Group A was superior to the other three groups.Conclusions Ipsilateral C7 transfer to the upper trunk of brachial plexus combined with the spinal accessory nerve to the suprascapular nerve is found to be significantly effective on treatment of the root avulsion of C5 and C6 of the brachial plexus.