尺神经部分转位肌皮神经二头肌支治疗早晚期臂丛神经损伤

目的]臂丛神经上中干损伤的修复治疗中肘屈曲功能是最为重要的.在已有的几种恢复肘关节屈曲功能的神经转位手术中,部分尺神经转位肌皮神经的手术(Oberlin' s method)是最新的方法.本报告应用Oberlin' s手术治疗早期和晚期臂丛神经上中干损伤的初步经验.方法]5例臂丛神经上中干损伤的患者采用了Oberlin's手术进行伤肢肘关节屈曲功能的恢复治疗.患者平均年龄28岁,随访6～15个月.早期手术2例,分别伤后6个月和8个月手术.晚期病例3例,分别于伤后12～18个月实施手术.术后持续性进行肱二头肌、肘关节屈曲肌力、手内肌握力、尺神经支配区感觉测试.结果]所有病例都恢复了肘关节的屈曲功能,都有3级以上的肱二头肌肌力恢复.2例早期病例术后1周内出现肱二头肌主动收缩,肘关节主动屈曲功能正常恢复时间平均6个月,平均肌力恢复4+级.3例晚期病例术后平均3个月出现肱二头肌收缩,肘关节主动屈曲功能正常恢复时间平均10个月,平均肌力恢复3+级.3例术后出现尺神经支配区感觉减退,1个月后自动恢复.结论]Oberlin' s手术是治疗臂丛神经上中干损伤,快速有效恢复肘关节主动屈曲功能的有效方式.

Nerve transfer to biceps muscle using a part of ulnar nerve for elbow flexion restoration in acute and delayed upper brachial plexus injury

Objective]The purpose of this study was to describe mid report the result of the ulnar nerve transfer to biceps muscle to restore elbow flexion after acute and delayed upper brachial plexus injuries.Methods]Two patients with acute brachial plexus injury (the time between the injury and the operation were six and eight months) and three patients with delayed brachial plexus injury(the time between the injury and the operation were from twevle to eighteen months) underwent nerve transfer using fascicles of the ulnar nerve to the motor branch of the biceis muscle. The average age of the patients was twenty eight and the mean follow-up periods were nine months after the surgery. Patients were evaluated with regard to reinnervation of the biceps, ulnar nerve function, elbow flexion strength, and grip strength.Results]For the two acute patients, the first sign of biceps muscle contraction were observed within 1 week, the average time required for reinnervation of the biceps after nerve fascicle transfer was within six months. For the three delayed patients, the first sign of bicep muscle contraction was observed in about three month, and the average time required for reinnervation of the biceps was ten months.Hypoesthesia of the ulnar nerve was clinically abserved in three patients, but this symptom disappeared within month with no treatment.Compared with those delayed cases, the acute patients had faster and better recovery of their olbow flexion function.However, all patients achieved grade-3 or better elbow flexion strength according to the grading system of the Medical Research Council.Conclusion]The author recommend this safe, simple and effective Oberlin procedure for brachial plexus injuries involving the C5、6 or C5~7 nerve roots.