臂丛下干损伤不同修复术式的疗效比较

目的评价臂丛神经下干损伤不同修复术式的疗效。方法研究并比较26例臂丛神经下干损伤患者用3种不同神经移位修复正中神经后的疗效。A组:肌皮神经肱肌支移位(6例),B组:健侧C7移位(10例),C组:肋间神经移位(10例)。术后平均随访15个月,观察正中神经功能恢复情况,并测定其握力、肌力和正中神经的运动神经传导速度(MNCV)和复合肌肉动作电位(CMAP)的潜伏期和波幅。结果A组5例能完成屈指动作,1例仅随访6个月屈指动作尚未恢复。B组5例能完成屈指动作,5例不能。C组6例能完成屈指动作,4例不能。术后3、6、12个月的握力和肌力,A组与B、C组相比差异均有统计学意义(P<0.05);B、C组相比差异无统计学意义(P>0.05)。术后3、6、12个月,A组正中神经CMAP的潜伏期较B、C组增快、波幅增高(P<0.05);正中神经的MNCV快于B、C组(P<0.05),B、C组相比差异无统计学意义(P>0.05)。结论肌皮神经肱肌支移位,由于神经再生至正中神经支配靶肌肉的距离比健侧C7和肋间神经短,故其屈指功能的恢复明显好于B、C组。

Treatment outcome of various reconstructive procedures of brachial plexus lower trunk injuries: a comparative study

Objective To evaluate the treatment outcome of various reconstructive procedures of brachial plexus lower trunk injuries. Methods 26 cases of adult lower trunk injuries treated from October 2001 to August 2004 were reviewed. Three neurotization methods were applied to repair the median nerve for restoration of finger flexion. In group A (n=6) brachialis muscle branch of the musculocutaneous nerve was transferred. In group B (n=10) contralateral C 7 transfer was done. In group C (n=10) the intercostal nerves were sutured to the median nerve. The average follow up period was 15 months. Restoration of median nerve function was evaluated by measuring the grip strength, muscle power, median nerve conduction velocity (MNCV) and compound muscle action potential (CMAP).Results Finger flexion was achieved in 5 cases of group A. No finger flexion was observed in the rest one due to limited 6 months postoperative duration. 5 out 10 cases in group B recovered finger flexion while the other 5 cases had no sign of recovery. For group C, finger flexion was seen in 6 cases but absent in 4 cases. Grip strength and muscle power tested 3 months, 6 months, and 12 months postoperatively were better in group A than in groups B and C. The difference was statistically significant(P<0.05). There was no difference between group B and group C(P>0.05). MNCV was faster in group A than in groups B and C. CMAP of group A also showed shorter latent period and larger amplitude(P<0.05). No difference was seen between group B and group C. Conclusion Transfer of brachialis muscle branch of the musculocutaneous nerve to the median nerve is a better option for restoration of finger flexion in that neurotization is located closer to the target muscle.