健侧颈7神经根移位治疗臂丛损伤的疗效观察

目的 观察健侧颈，神经根移位术后患侧肢体的功能恢复及对健侧颈7神经根所支配区运动、感觉的影响。方法 对25例全臂丛神经根性撕脱伤患者，均采用健侧颈7神经根（全部10例，后股15例）移位修复，其中修复上千6例，正中神经13例，桡神经3例，肌皮神经3例；并观察手术前、后健侧颈，神经根所支配肌肉功能和感觉的变化及患侧肢体的功能恢复。术后5～28个月随访到24例。结果 对健侧肢体的影响：10例健侧颈，神经根全部切断者，术后均出现不同程度的感觉运动障碍，主要表现为桡侧1～3指感觉减退、肢体酸胀、痛和不同程度的肢体无力，术后1年完全恢复正常。1例出现伸拇、伸指不能，1年半后仍无明显恢复。15例健侧颈，神经后股切断者，其中1例失访。术后2例无明显感觉障碍，但伸腕、伸指无力，3周后恢复正常。12例出现示、中指感觉异常，8例于术后3～4周后逐渐恢复正常，4例于6个月后症状消失。患肢功能恢复：术后随访至12～18个月，受区神经支配的部分肌肉获得不同程度的功能恢复。结论 健侧颈7神经根移位术后健侧肢体运动感觉功能不遗留明显的远期损害，但也偶有解剖因素导致其支配区功能的无法恢复。颈7后股移位能为受区神经提供足够的运动纤维，同时也减少了对健侧肢体感觉的影响。

Clinical outcome of contralateral C7 transfer for treatment of brachial plexus injuries

Objective To observe the affect on the sensory and motor function of the healthy limb and the functional recovery of the repaired limb after contralateral C_7 transfer.Methods 25 patients with brachial plexus root avulsion injuries were treated with contralateral C_7 transfer.The entire middle trunk of the healthy side brachial plexus was transected in 10 of them,and the posterior division was transected in the rest patients for transfer.Recipient nerves included upper trunk in 6 cases,median nerve in 13 cases,radial nerve in 3 cases,and musculoeutaneous nerve in 3 cases.24 patients were followed-up for 5 to 28 months to evaluate the influenee on the healthy limb function and the motor recovery of the recipient nerves in the affected limb.Results In the 10 patients where the entire middle trunk was transected,there was more or less sensory and motor impairment of the healthy limb.Decreased sensation was noted in the radial 3 digits.Discomfort and weakness of the healthy limbs were also reported.Those,however,all dissolved within one year.There was deficit of finger and thumb extension in 1 case that didn' t show obvious signs of recovery 1.5 years following the surgery.In those 15 cases where only the posterior division was taken,paresthesia of index and long finger appeared in 12 cases.8 of them recovered 3-4 weeks later,while 4 of them recovered 6 months later.In 2 cases there was no obvious sensory loss,but weakness of wrist and finger extension occurred,which recovered 3 weeks later.As for functional recovery of the affected limbs,motor function of the neurotized nerves recovered to various extent 1-1.5 years after the operation.Conclusion There were no long-term significant sensory and motor impairments in the healthy limbs after C_7 transfer.However anatomical variation factors could occasionally lead to unrecoverable functional deficit.The posterior division of C_7 transfer was enough to provide motor fibers to the recipient nerves.In the meantime,partial transection of C_7 could diminish the sensory and motor loss in the healthy limb.