中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (3): 470-476.doi: 10.4103/1673-5374.228730

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

修复全臂丛神经根性撕脱伤如何达到最好的效果：73例回顾性分析

  

  • 收稿日期:2017-12-28 出版日期:2018-03-15 发布日期:2018-03-15
  • 基金资助:

    国家自然科学基金（H0605/81501871）

 Evaluation of nerve transfer options for treating total brachial plexus avulsion injury: a retrospective study of 73 participants

Kai-ming Gao1, 3, 4, Jing-jing Hu1, 2, Jie Lao1, 3, 4, Xin Zhao1, 3, 4   

  1. 1 Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
    2 Nursing Department, Huashan Hospital, Fudan University, Shanghai, China
    3 Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
    4 Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
  • Received:2017-12-28 Online:2018-03-15 Published:2018-03-15
  • Contact: Jing-jing Hu,jingjing_hu976@163.com.
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. H0605/81501871

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摘要：

尽管目前对于全臂丛神经根性撕脱伤的诊断和显微外科修复技术都取得了较大的进步，但是其疗效仍然不是十分理想。供体神经数量有限以及对本已有限的供体神经利用不合理是影响疗效的一个重要的原因。回顾性资料分析希望探索出一个相对合理的全臂丛根性撕脱伤的修复方案。对73例全臂丛神经根性撕脱伤患者进行随访，平均随访时间为术后7.3年。随访结果发现，屈肘功能恢复者中有膈神经移位25例、通过膈神经移植19例、肋间神经移位17例或健侧颈7神经重建12例，各种方法的修复效果无显著性差异；肩关节功能通过前路副神经移位27例、后路副神经移位10例、肋间神经移位5例以及副神经联合肋间神经移位重建31例，其中副神经联合肋间神经移位法的效果最好。伸肘功能恢复者中有肋间神经移位25例，修复效果优于侧颈7神经移位10例；正中神经功能恢复者中有健侧颈7神经全根移位33例修复效果优于部分健侧颈7神经根移位40例。伸腕、伸指功能恢复者中有肋间神经移位修复31例。回顾性分析数据显示，全臂丛根性撕脱伤修复要达到最好的修复效果，推荐采用膈神经移位重建屈肘功能，副神经联合肋间神经移位重建肩关节功能，肋间神经移位重建伸肘功能，健侧颈7神经全根移位重建正中神经功能，肋间神经移位重建伸腕伸指功能。试验已经在北美临床试验中心注册(NCT03166033)。

orcid:0000-0003-4343-6050(Jing-jing Hu)

关键词: 神经再生, 周围神经再生, 臂丛神经根性撕脱伤, 神经移位, 膈神经, 副神经, 健侧颈7神经, 肋间神经, 肩关节功能, 肘关节功能, 正中神经, 桡神经

Abstract:

Despite recent great progress in diagnosis and microsurgical repair, the prognosis in total brachial plexus-avulsion injury remains unfavorable.Insufficient number of donors and unreasonable use of donor nerves might be key factors. To identify an optimal treatment strategy for this condition, we conducted a retrospective review. Seventy-three patients with total brachial plexus avulsion injury were followed up for an average of 7.3 years. Our analysis demonstrated no significant difference in elbow-flexion recovery between phrenic nerve-transfer (25 cases), phrenic nerve-graft (19 cases), intercostal nerve (17 cases), or contralateral C7-transfer (12 cases) groups. Restoration of shoulder function was attempted through anterior accessory nerve (27 cases), posterior accessory nerve (10 cases), intercostal nerve (5 cases), or accessory + intercostal nerve transfer (31 cases). Accessory nerve + intercostal nerve transfer was the most effective method. A significantly greater amount of elbow extension was observed in patients with intercostal nerve transfer (25 cases) than in those with contralateral C7 transfer (10 cases). Recovery of median nerve function was noticeably better for those who received entire contralateral C7 transfer (33 cases) than for those who received partial contralateral C7 transfer (40 cases). Wrist and finger extension were reconstructed by intercostal nerve transfer (31 cases). Overall, the recommended surgical treatment for total brachial plexus-avulsion injury is phrenic nerve transfer for elbow flexion, accessory nerve + intercostal nerve transfer for shoulder function, intercostal nerves transfer for elbow extension, entire contralateral C7 transfer for median nerve function, and intercostal nerve transfer for finger extension. The trial was registered at Clinical-Trials.gov (identifier: NCT03166033).

Key words: nerve regeneration, brachial plexus-avulsion injury, nerve transfer, phrenic nerve, accessary nerve, contralateral C7 nerve, intercostal nerve, shoulder function, elbow function, median nerve, radial nerve, neural regeneration