目的 观察健侧C_7,经椎体前通路移位与下干直接吻合,重建儿童创伤性臂从神经撕脱伤屈指功能的效果.方法 健侧C_7,在其前后股的远端切断,向近端游离至椎间孔,经椎体前通路牵至患侧.游离患侧臂丛下干及内侧束,切断下干后股及胸前内侧神经.将正中神经、尺神经及前臂内侧皮神经自内侧束的起始处一直游离到上臂中段.息肩前屈、内收至0°位,肘关节屈曲90°,上提患侧下干并与健侧C_7,直接吻合.2004年8月至2008年3月对20例患儿进行了健侧C_7,与患侧下干或内侧束直接吻合术.其中男16例,女4例;年龄5-18岁,平均13岁;伤后到手术时间1-11个月,平均4.6个月.全臂丛撕脱伤13例,中、下干撕脱伤7例.为减少吻合口张力,11例进行了肱骨短缩,短缩长度2.5-4.5 cm,平均(3.1±0.7)cm.结果 术后患者随访时间12-51个月,平均 27.4个月.屈指肌力4级18例,2级2例;屈拇长肌力4级10例、3级8例、2级2例.小指展肌肌力3级l例,2级1例;拇短展肌肌力3级1例.结论 健侧C_7,与患侧下干直接吻合,由于只有一个吻 合口及缩短了神经再生的距离,其重建屈指、屈拇功能的效果满意,并可恢复手内在肌的部分功能.%Objective To observe the primary result of finger flexion reconstruction in the procedure of direct anastomosis of contralateral C_7,transfered through the prespinal route with lower trunk in children suffered traumatic brachial plexus root avulsion injury.Methods On the healthy side.the C_7 nerve root was identified anatomically and transected at the level of division by dissecting its anterior and posterior division as far distal as possible up to the level where the nerve fihers interweaving with other division,then the contralateral C_7,nerve root W88 dissected proximally up to the neuroforamina.The contralateral C_7 nerve root was transferred to contralateral side through the prespinal route.The entire brachial plexus of suffered side was exposed through the union incision superior and inferior to the clavicle.The lower trunk was identified and dissected proximally to the C_8 and T_1 nerve root which were severed at the lateral margin of anterior scalenus.and then the dorsal division and anterior medial pectoral nerve of lower trunk were severed.The median nerve,ulnar nerve and medial antebrachial cutaneout;nerve were identitled from the Origin and dissected distally continue to the midpoint of upper arm,and lateral head of the median nerve was severed so that the lower trunk.medial cord and median nerve,ulnat nerve and medial antebrachial cutaneous nerve can be fully mobilized.Anteriorly flexion and adduction of the should at 0°and flexion elbow at 90°,this could allow cousiderable length to he gained when pulling the lower trunk proximally,direct anastomosis of contralaterul C_7 with lower trunk wag performed.If there was any tension exist,the appropriate humerous shorten osteotomy should be performed.From August 2004 to December 2008.20 children including 13 cases with total brachial plexus nerve root avulsion injury and 7 cages with middle and lower trunk avulsion injury were repaired by this procedure.Twenty cases including 16 males and 4 females, the average age was 13 years with a range of 5 to 18 years.The interval from injury to operation ranged l to 11 months with a mean of 4.6 months.Eleven patients were performed the humeral shorten osteotomy,the length of the humeral shorten was 2.0-4.5 cm.with the mean of(3.1±0.7)cm Results The follow up period was 12 to 51 months.with the average of 26 months.The muscle strength of finger flexion attained M 4 in 18 cases,M 2 in 2 cases.The motor function of thumb flexion gained M 4 in 10 cases.M 3 in 8 cases, M2.in 2 cases.Of the 2 cases achieved motor function of intrinsic muscles of the hand of M3.Conclusions The direct anastomosis of contralateral C,with lower trunk in children with traumatic brachial plexus avulsion injury can improve the effect of reconstructing the function of finger flexion because it reduces one never anastomosis site and decreases the distance of nerve regeneration comparod with the traditional method.With this modified procedure.the functional recovery of intrinsic muscles of the hand in children with traumatic brachial plexus avulsion injury is becoming possible.
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