摘要
目的探讨利用前臂内侧皮神经桥接至尺神经深支的健侧颈7神经根移位术的早中期电生理恢复情况。方法自2016年7月至2017年6月,我们收治全臂丛神经损伤患者40例,其中20例行健侧颈7神经根通过带蒂尺神经和前臂内侧皮神经桥接同时修复正中神经及尺神经深支(实验组),20例行健侧颈7神经根通过带蒂尺神经桥接修复正中神经(对照组)。行肌电图检查评估疗效,获得患侧拇短展肌、小指展肌、背侧骨间肌的神经电生理早期恢复情况。结果术后随访时间为19~30个月,平均24.9个月。对照组中4例患者可于拇短展肌记录到运动单位电位(motor unit potential,MUP),募集相少量,其中1例患者还可于拇短展肌记录到复合肌肉动作电位(compound muscle action potential,CMAP);所有患者均未能在小指展肌及背侧骨间肌记录到MUP。实验组中5例患者可于拇短展肌记录到少量MUP,其中2例患者还可于拇短展肌记录到CMAP;5例患者可于小指展肌记录到少量MUP,2例患者可于背侧骨间肌记录到少量MUP,1例患者可于小指展肌及背侧骨间肌记录到CMAP。两组患者患肢肌电图检测结果中小指展肌的MUP恢复差异有统计学意义(P<0.05),而桡侧腕屈肌及拇长屈肌的CMAP潜伏期及波幅差异无统计学意义(P>0.05)。结论前臂内侧皮神经桥接至尺神经深支的健侧颈7神经根移位术,在不影响正中神经恢复的前提下,从神经电生理角度证实该术式使全臂丛神经根性损伤患者更多的手内肌功能得到了早期恢复。
Objective To explore the early and mid-term electrophysiological recovery of the contralateral C7 nerve transfer using the medial antebrachial cutaneous nerve to bridge the deep branch of ulnar nerve.Methods From July 2016 to June 2017,40 patients with total brachial plexus injury were treated,of which 20 cases were treated with the repair of median nerve and deep branch of ulnar nerve through the bridge of pedicled ulnar nerve and medial cutaneous nerve of forearm(experimental group),and 20 cases were treated with the repair of median nerve through the bridge of pedicled ulnar nerve(control group).The early electrophysiological recovery of abductor pollicis brevis,abductor digiti minimis and dorsal interosseous muscles in the affected side was evaluated by electromyography(EMG)examination.Results The follow-up time was 19 to 30 months with an average of 24.9 months.In the control group,motor unit potential(MUP)could be recorded in abductor pollicis brevis in 4 cases,a small amount of recruitment phase,and compound muscle action potential(CMAP)could be recorded in abductor pollicis brevis in 1 case.MUP could not be recorded in abductor digiti minimi and dorsal interosseous muscles in all the patients.In the experimental group,a small amount of MUP could be recorded in abductor pollicis brevis in 5 cases,CAMP could be recorded in abductor pollicis brevis in 2 cases.A small amount of MUP could be recorded in the abductor digiti minimi in 5 cases,in the dorsal interosseous muscle in 2 cases,and CAMP could be recorded in abductor digiti minimi and dorsal interosseous muscles in 1 case.There was significant difference between the two groups in the recovery of MUP of abductor digiti minimi(P<0.05).There was no significant difference in CMAP latency and amplitude of flexor carpi radialis muscle and flexor pollicis longus between the two groups(P>0.05).Conclusion The contralateral C7 nerve transfer by bridging medial antebrachial cutaneous nerve to deep branch of ulnar nerve was confirmed electrophysiologically that the
作者
于虎
刘宇洲
劳杰
Yu Hu;Liu Yuzhou;Lao Jie(Department of Hand Surgery,Huashan Hospital Affiliated to Fudan University,Key Laboratory of Hand Reconstruction of Health Ministry,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery,Shanghai 200040,China)
出处
《中华手外科杂志》
CSCD
北大核心
2020年第2期95-98,共4页
Chinese Journal of Hand Surgery
基金
国家自然科学基金资助项目(81572127)。
关键词
臂丛
神经移位
健侧颈7神经根
前臂内侧皮神经
尺神经深支
Brachial plexus
Nerve transfer
Contralateral C7 nerve root
Medial antebrachial cutaneous nerve
Deep branch of ulnar nerve
