摘要
目的探讨臂丛神经瘤切除后,神经移植或移位术对产瘫患儿上肢功能的影响及变化规律,为该手术在临床推广提供依据。方法2 0 0 1年3月至2 0 0 2年4月,对49例早期产瘫患儿,采用臂丛神经瘤切除、神经移植或移位术修复臂丛神经。术后经1、3、12个月随访肩外展、屈肘、伸腕和伸掌指关节功能,用配对t检验比较手术前后患肢功能的差异。结果结合术前体检、术中各神经根探查及电生理检测结果,手术探查发现C5、6神经根以椎孔外断裂为主;C7神经根多为根性撕脱;C8、T1神经根常为轻度损伤(SunderlandⅡ度以下)或根性撕脱。术后1个月原已部分恢复的肩外展、屈肘、伸腕和伸掌指关节动作均丧失;术后3个月肩外展功能已优于术前,屈肘、伸腕和伸掌指关节功能恢复到术前水平;术后1年肩外展、屈肘、伸腕和伸掌指关节功能明显优于术前(P <0 .0 1)。结论对有早期手术探查指征的产瘫患儿,在切除创伤性神经瘤的同时修复臂丛神经,术后不会导致肢体原有功能的不可逆损害。
Objective The upper limb functional outcomes in infants with obstetric brachial plexus palsy(OBPP) who underwent neuroma resection and brachial plexus reconstruction by nerve transfer or/and nerve grafting were investigated to provide basis for broad clinical application of this surgical strategy. Methods Forty nine early OBPP cases surgically treated during March 2001 and April 2002 were involved. Surgical procedures included neuroma excision and nerve transfer or/and nerve grafting. At 4 weeks ,3 months, and 12 months postoperatively, functions of shoulder abduction, elbow flexion, wrist extension and metacarpophalangeal (MCP) joint extension were evaluated. Pre-and post-operative functions of the affected limbs were compared and paired-sample t test was applied to assess the changes. Results Surgical exploration and intra-operative electrophysiological examination revealed C_5 and C_6 being extra-foramen rupture, C_7 being root avulsion, and C_8 and T_1 being slight stretch (Sunderland Ⅱ or minor) or root avulsion in most cases. At post-op 4 week follow-up, the already-acquired function of shoulder abduction, elbow flexion, wrist extension, MCP joint extension were found lost in all patients. Shoulder abduction increased significantly by 3 months postoperatively, surpassing preoperative level. The function of elbow flexion, wrist extension, and MCP joint extension reached preoperative level. One year follow-up showed remarkable improvement in all assessed functions(P<0.05). Conclusion Neuroma resection and nerve reconstruction in OBPP cases with early surgical exploration indications leads to no irreversible loss of preoperative upper limb function.
出处
《中华手外科杂志》
CSCD
北大核心
2005年第2期67-69,共3页
Chinese Journal of Hand Surgery
基金
国家973重点基础研究发展计划资助项目(2003CB515305)
