改良式健侧颈7神经移位术治疗臂丛根性撕脱伤

目的研究探讨健侧颈7神经移位术不同术式及不同神经吻合方法的特点，并在一定程度上判断各方法对神经再生的影响及予后。方法本组64例臂丛神经根性撕脱伤的患者将其分成A，B两组。A组30例为实验组，将健侧颈7神经根部分切断，与患侧尺神经远端行部分端端吻合（尺神经自颈椎椎体前食管后穿过）；尺神经近端自然分成两束，分别与患侧正中神经、桡神经远端一期行端端吻合；B组34例为对照组，将健侧颈7神经根完全切断，与患侧尺神经远端行端端吻合（尺神经自颈前皮下穿过），患侧尺神经近端于二期（术后8个月）与患侧正中神经或桡神经远端行端端吻合。术后定期观察随访并记录分析结果。结果术中神经吻合张力A组明显小于B组；术后健侧上肢短期感觉运动异常改变，A组较B组发生率低，且症状消失快，但电生理检查无显著差异（P〉0．05）。术后患肢功能恢复结果，A组较B组无显著差异（P〉0．05）。结论健侧颈7部分切开，术后减少了上肢感觉、运动异常的发生率，且症状消失快，同时吻合神经的直径相当，也减少了供区神经资源浪费；患侧尺神经自颈椎椎体前食管后穿过减少了神经吻合的张力；一期手术即可完成患侧上肢两条神经移植，患者痛苦小，病程短，费用低，易接受。因此A组改良的方法优于B组常规的方法。

Modified methods of contralateral C7 transfer for treatment of the brachial plexus root avulsion injuries

Objective To study the feature of different methods and anastomosis in the procedure of contralateral C7 transfer and to estimate the influence and prognosis of nerve regeneration in different methods.Methods 64 cases of brachial plexus root avulsion injury patients were randomly divided into A and B two groups.In group A,30 cases,the contralateral C7 root were partially incised and anastomosed with the distal end of ipsilateral ulnar nerve in the same time,the proximal end were anastomosed with the distal end of ipsilataral median and radial nerve.In group B, 34 cases,the contralateral C7 root were completely incised and anastomosed with the distal end of ipsilataral ulnar nerve,the proximal end was anastomosed with the distal end of ipsilataral median and radial nerve at 8 months postoperatively.All the patients were followed up to record and analyse the treatment results.Results The nerve tension of anastomosis in group A was less than group B;The motor and sensory dysfunction of the contralateral upper limbs was less in group A than group B and recovered quickly;there was no significantly difference in electrophysiology （P 〉 0.05）.The motor function and electrophysioIogy of the ipsilataral upper limbs and had no difference between the modified and ordinary procedure of contralateral C7 transfer P 〉0.05）.Conclusion Modified methods of the contralateral C7 transfer is superior to routine method, because it has the advantages of less suffering and cost, and result in less nerve dysfunction and more rapid recovery. We think the method of group A is more better than group B.