尺神经部分转位肌皮神经对臂丛损伤屈肘功能恢复的观察

目的探讨部分尺神经转位肌皮神经二头肌支重建臂丛神经损伤屈肘功能的临床疗效。方法埘5例臂丛神经止中干损伤的患者（早期2例，晚期3例）采用部分尺神经转位肌皮神经二头肌支手术，随访6～18月（分别于伤后6、8、12、13、18个月实施手术）。术后持续性进行肱二头肌肌动、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（肱二头肌肌力均恢复到3级以上）。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月后自动恢复。结论部分尺神经转位肌皮神经二头肌支手术是治疗臂丛神经上中干损伤，快速确效恢复肘关节主动屈曲功能的优良方式。

Nerve Transfer to Biceps Brachii using Partial Ulnar Nerve for Restoration of Elbow Flexion after Injury of Brachial Plexus

Objective To describe and report the result of ulnar nerve transfer to biceps brachii to restore the function of elbow flexion after injuries of upper brachial plexus. Methods Two patients with acute brachial plexus injury （ the lasting time were six and eight months, respectively） and another three patients with delayed braehial plexus injury. （the lasting time were from twevle to eighteen months） underwent nerve transfer using fascicles of the ulnar nerve to the motor branch of the biceps muscle. The average age of the patients was 28 years and the follow-up periods were at least six months after the surgery. Patients were evaluatcd 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 a 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 bieep,muscle contraction was observed in about three month, and the average time required for reinnervation of thc biceps was ten months. Hypoesthesia of the ulnar nerve was clinically observed in three patients, but this symptom disappeared in a month without treatment. Compared with those of delayed cases, the acute patients had faster and better recovery of their elbow flexion function. However, all the patients achieved grade-3 or better elbow flexion strength according to the grading system of the Medical Research Council. Conclusion We recommendhis safe, simple and effective Oberlin procedure for brachial plexus injuries involving the C5-C6 or C5-C6-C7 nervc roots.