摘要
目的探讨神经移植与移位手术对早期分娩性臂丛神经麻痹(产瘫)的治疗价值。方法对48例屈肘功能无恢复(肌力0～1级)的TassinⅡ～Ⅳ型产瘫患儿于出生后3～14个月行臂丛神经探查手术。术中根据损伤性质的不同而采用相应的神经修复方式:即对创伤性神经瘤,行神经瘤切除、神经移植及移位;对神经根性撕脱伤,行神经移位;对神经外观基本正常且术中电生理检测提示神经连续性存在者,行神经松解。结果术后最短随访36个月,采用Gilbert肩、肘关节和Raimondi手功能评定系统进行评价。13例TassinⅡ型患儿的肩、肘关节及手功能评分分别从术前的平均0.54、1.92和3.23分提高到术后的3.77、4.92和4.31分;11例Ⅲ型患儿自术前的平均0.46、1.82和1.91分改善至术后的3.27、4.18和3.64分;24例Ⅳ型患儿由术前的平均0.25、1.25和0.33分提高到术后的2.92、3.46和2.83分。7例患儿(14.6%)在恢复过程中出现肩关节内旋挛缩,但均未发生肩关节脱位。结论创伤性神经瘤切除、神经移植结合移位手术治疗早期产瘫疗效显著。
Objective To evaluate the efficacy of the nerve grafting and nerve transfer (neurotization) in the treatment of early obstetrical brachial plexus palsy(OBPP). Methods 48 cases with TassinⅡ-Ⅳ lesion who had no any recovery of elbow flexion, the brachial plexus were explored from 3 to 14 months after birth. The method of nerve repair depended on findings during operation. For the traumatic neuroma, it should be resected and the defect be repaired by nerve grafting with neurotization; the root avulsion was repaired by neurotization; neurolysis was only performed to those plexus that looked nearly normal and had a positive reaction of neurophysiology as tested intra-operatively. The reconstructive procedures included: C5→upper trunk, accessory →supraspinal nerve (2 cases); C5,6→the posterior and the anterior division of the upper trunk respectively, accessory →supraspinal nerve (25 cases); C5,6→the posterior and anterior divisions of the upper trunk respectively, C7→middle trunk, accessory →supraspinal nerve (4 cases); C5→posterior cord, C6→lateral cord, accessory →supraspinal nerve (5 cases); C5→anterior division of the upper trunk, C6→C8, accessory →supraspinal nerve (1 case); C5-7→the posterior, lateral and medial cords respectively, accessory →supraspinal nerve (4 cases); C5→upper trunk, C6→lower trunk (or medial cord), accessory →supraspinal nerve (2 cases); C5,6→the lateral and medial cords respectively, accessory →supraspinal nerve (3 cases); neurolysis (2 cases). Results All the patients were available at follow-up at least for 36 months, who were studied according to both of the Gilberts shoulder and elbow rating system and the Raimondis hand scale system. The score of shoulder, elbow, and hand in 13 cases with Tassin Ⅱ lesion improved from preoperative 0.54, 1.92 and 3.23 to postoperative 3.77, 4.92 and 4.31 respectively; 11 cases with Tassin Ⅲ rose from 0.46, 1.82 and 1.91 to 3.27, 4.18 and 3.64, and 24 cases with Tassin Ⅳ had an elevation from 0.25,
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第8期449-452,共4页
Chinese Journal of Orthopaedics
