健侧C7 神经根经椎体前移位修复臂丛上干损伤的中期临床随访

目的 观察健侧C7 神经根经椎体前通路移位修复臂丛上干损伤重建肩外展、屈肘功能的中期效果.方法 健侧C7 神经根经椎体前通路移位修复臂丛上干损伤患者15例,男14例,女1例;年龄15～43岁,平均30岁.全臂丛撕脱伤7例,上、中干撕脱伴下干不全损伤6例,上、中干损伤2例.健侧C7 神经根经椎体前通路移位到患侧臂丛上干的距离平均(7.6±1.7)cm,8例同时行副神经或膈神经移位单独修复肩胛上神经.结果 随访36～63个月,平均50个月.健侧上肢用力内收时,12例患者的肱二头肌、三角肌、胸大肌锁骨部、冈上肌肌力(8例来自副神经或膈神经的支配)均达到4级,大脑皮层运动支配中枢发生临床转化;另3例肌力为3级或以下,尚未发生大脑皮层运动支配中枢的临床转化.健侧上肢用力内收时,8例肩胛上神经单独修复者的肩外展角度平均78.0°,另7例平均43.1..结论 健侧C7 神经根经椎体前通路移位可用于修复臂丛上千损伤,桥接神经的距离短,重建肩外展及屈肘功能的效果良好,大脑皮层运动支配中枢可发生临床转化.

Median-term follow-up of contralateral C7 nerve root transfer through the prespinal route to repair the upper trunk in the patients with brachiai plexus injury

Objective To observe the median-term outcome of functional recovery of shoulder abduction and elbow flexion and transhemispheric functional reorganization of motor cortex after contralateral C7 nerve root transfer through the prespinal route to repair the upper trunk in patients with brachial plexus injury.Methods The muscle strength grade of shoulder abduction and elbow flexion were evaluated in 15 patients who accepted the operation of contralateral C7 nerve root transfer through the prespinal route to repair the upper trunk more than three years,all the patients including 14 males and 1 female,with an average age of 30 years (range,15-43 years).Seven cases were total brachial plexus root avulsion,6 cases were C5,C6 and C7 nerve root completely avulsion and partial lesion of the lower trunk,2 cases were C5,C6 and C7 nerve root completely avuision.The length of the graft nerve bridging the contralateral C7 nerve root and upper trunk of the injured side was (7.6±1.7) cm,8 of the 15 cases with the suprascapular nerve neurotized independently by spinal accessory nerve or phrenic nerve transfer.Results The strength grade of muscle including biceps,deltoid,supraspinatus and major pectoral neurotized by crossed C7 nerve root was grade 4 in 12 of 15 patients when the normal upper limber adduetion maximal,and all the 12 patients could conscious command the shoulder abduction and elbow flexion of the injured arm without adduetion of the intact arm,but the strength of muscle neurotized by cross C7 nerve root was grade 3 or less in other 3 eases and all the 3 patients could not conscious command the muscle contraction neurotized by cross C7 nerve root but depend on the adduction of the intact ann.When the health upper limber maximally addueting,the average angle of shoulder abduction was 78.0° in the group with the suprascapular nerve neurotized independently by spinal accessory nerve or phrenie nerve transfer,and 43.1° in other 7 cases.Conclusion The functional recovery of shoulder abduction and shoulder flexion reconstructed by crossed C7 nerve root transfer through the prespinal route to repair the upper trunk in patients with brachial plexus injury is satisfactory because of shorter length nerve bridging than traditional method,most of the patients are able to initiate a elbow flexion and shoulder abduction in the injured arm without an adduction or extension of the preserved arm.