【摘要】 目的探讨健侧颈₇神经根经椎体前路移位修复臂丛神经撕脱伤的最短通路及其安全性,并分析其应用指征和临床疗效。方法将健侧颈₇神经根自干股交界处或锁骨后束部起始部切断,近端游离至椎间孔,将前斜角肌切断,经椎体前食管后间隙,通过5～7股皮神经桥接或直接吻合,修复患侧上干或锁骨下外侧束和后束。临床修复8例,5例为全臂丛神经根性撕脱伤,3例为臂丛上中干根性撕脱伤伴下干部分损伤。结果5例患者术后1周内在咳嗽、进食时有轻度健侧手指麻木感,随后逐渐消失;2～3个月后患侧颈部扣击健侧手指出现麻木感,SSEP在术后3个月时均能引出,7个月时能引出支配肌CMAP,12个月时恢复了肩肘功能。结论切断双侧前斜角肌不仅可以缩短移值神经的长度,而且颈₇神经根翻转通路更通畅、安全,有利于神经再生和患肢功能恢复。锁骨上修复主要重建上干前股、上干后股、肩胛上神经功能;锁骨下修复时,主要重建外侧束加后束。更多还原

【Abstract】 Objective To investigate a shorter and safer route for contralateral C₇ nerve root transfer. Methods Eight male patients were treated from Dec2005 to Nov.2006Their range of age was from 22 to 43 years with an average of 30 yearsFive cases had total brachial plexus avulsion.The operative delay was from 2 to 6 months（mean:4 months）.The sealenus anterior muscle was transected before a prespinaJ & ret- ropharyngeal tunnel was madeThe contralateral C₇ nerve root was used to repair the upper trunk or the infra- clavicular lateral cord and posterior cord of injured side via this routeusing direct anastomosis or nerve graft- ing.Results The length of the harvested contralateral C₇ nerve root was（4.67±0.52em in the early 5 casesThe nerve graft was6.25±0.35）em long for repairing supraclavicular brachial plexus and(8.56±0.45cm long for repairing infraclavicular brachial plexusThe length of the harvested contralateral C₇ nerve root averaged 6.85cm in the other 3 cases2 of which had direct anastomosis to the residual nerve C₅ and C₆ nerve roots and the other used nerve graft of 3 cm in lengthTransient contralateral sensory symptoms were re- ported in most patientsAt 3 months followups6 patients had tingling sensation on the contralateral fingers with percussion on the injured cervical areaIpsilateral SSEP could be recorded by stimulating at 2 cm above sternoclavicular joint on the injured sideAt 7 months follow ups of 5 patientsCMAP could be recorded in bi- cepsdeltoids and infraspinatus or triceps with stimulation at Erb’s pointHoweverno clinical movements was noticedAt 12 months follow ups of 3 patientswe could observe early motor and sensory function recovery of those patients to different extent.Conclusion Transection of anterior scalenus muscle shortens the length of the transfer route and allows more efficient neurotizationThe procedure is convenient and safeprovided certain precautions being usedThe principal of contralateral C₇ nerve transfer are reconstruct the anterior divi- sions of upper trunkposterior divisions of upper trunk and suprascapular nerve when repairing the supraclavic- ula brachial plexusReconstruct the lateral cord and posterior cord when repairing the infraclavicula brachial plexusPostsurgical fasting for 4 days included foods and liquids will benefit of healing of anastomosed nerves and regenerationaud avoid complications.更多还原