健侧C7神经根与臂丛下干前股束支同时移位的可行性研究

目的 研究健侧C7神经根移位后再取臂丛下干前股束支进行移位的安伞件和可行性.方法 (1)解剖学研究:取40侧成人上肢标本,测量臂丛下干前股的直径及其至对侧上干的距离;分离下干前股的自然分柬,观察各束支在横断面上的分布特点和关系;计数重要束支的有髓神经纤维数目.(2)临床应用:全臂丛撕脱伤患者11例,男10例,女1例;年龄10～37岁,平均24.8岁.在行健侧C7神经根移位的同时,切取下干前股部分束支进行神经移位,于术后2～7 d、3个月、6个月时观察健侧上肢的感觉和运动功能变化.结果 (1)解剖学研究:下干前股均能分离出明显的自然分束,其中前上束支的面积约占下干前股的1/8～1/7,含有髓神经纤维(5974±1996)根,下干前股至对侧上干的距离为(16.9±1.3)cm.(2)临床应用:术后2～7 d,所有患者健侧上肢均出现不同程度的感觉障碍及肌力减弱,感觉障碍多为主观感觉麻木及两点辨别觉轻度减退,肌力多减弱至3～4级.随访3个月时,除2例伸腕、伸指肌力稍弱(M4)、1例前臂内侧感觉麻木未恢复外,其余患者均基本恢复正常;6个月时,伸腕、伸指肌力全部恢复正常.结论 健侧C7神经根切取后,健侧下干前股束支可以作为新的动力神经供体,提供较充足的动力神经纤维.临床初步应用证实该术式'发计安全、可行.

The safety and feasibility of using fascicle of anterior division of the lower trunk as donor nerve after contralateral C,nerve root transfer

Objective To study the safety and feasibility of using fascicle of eontralateral anterior division of the lower trunk (ADLT) as donor nerve for treatment of patients with total brachial plexus avulsion after C7 nerve root transferred.Methods The brachial plexus was exposed and the diameter of ADLT and the distance from ADLT to the contralateral upper trunk were measured on 40 cadaver specimens.The bundles of ADLT were carefully divided,and the course,location and orientation of each fascicle were recorded.One target faseicular of each specimen was made into histological slice,and the amount of medullated nerve fiber was counted.Eleven patients with total brachial plexus avulsion accepted contralateral C7 nerve root and ADLT fascicle transfer during November 2005 to September 2006.The functional changes of the healthy limbs were observed after the surgery.Results The distance from ADLT to the contralateral upper trunk was (16.9±1.3) cm.The diameter of the fascicle located in the AS quadrant of ADLT was (0.67±0.13) mm,and the fascicle contained 5974±1996 nerve fibers.In 2-7 d after the surgery,all the patients had some functional deficiency,such as numbness of the finger,weakness for extension of wrist and finger.But most of the symptoms were slight and had disappeared in 6 months.Conclusion Fascicle of ADLT which contains a great many medullated nerve fibers can be used as a new donor nerve for transfer after eontralateral C7 transfer.This procedure is safe and feasible according to the clinical cases.