摘要：
Objective To study the outcome of elbow flexion reconstruction of Oberlin operation (end to end neuroanastomosis of musculocunatenous nerve-bicep's branch to ulnar nerve) in the treatment of brachial plexus upper root avulsion and its long term result.Methods From January,2004 to July,2016,72 patients with brachial plexus upper root avulsion had received Oberlin operation (end to end neuroanastomosis of musculocunatenous nerve-bicep's branch to ulnar nerve),50 males and 22 females,35 cases on the left side and 37 on the right.An average age of 34 years (8-52 years),time from injury to operation were 3-9 months,an average of 5.5 months,an average of follow up were 3 years 7 months.All patients were diagnosed with brachial plexus upper root avulsion by comprehensive physical examination,electromyocardiogram and cervical MRI (make sure muscle strength innervated by ulnar nerve were ≥ M4).Among 72 patients,55 were C5-C6 root avulsion and 17 were C5-C7 root avulsion.Elbow flexion function and Bicep muscle's strength were measured after operation (muscle's strength was measured by British Medical Research Council score system M0-M5).Muscle's strength recovery was considered as poor if ＜M3 and it was considered as good if ≥M3.Results In 72 cases,62 were successfully followed up (86.11％).Seven patients were lost of follow up (9.72％) and 3 patients didn't received operation due to ulnar nerve anomaly (4.17％).Six-two patients were measured bicep's muscle strength at last follow up,among them there were 49 patients recovered muscle strength ≥M3 (79.03％) and 13 patients recovered muscle strength ＜M3 (20.97％).Conclusion Oberlin operation is an effective operation in the treatment of brachial plexus upper root avulsion,one thing noted in this operation is that biggest bicep branch of musculocutaneous nerve need to be selected and neuroanastomosis with ulnar nerve,otherwise post-operative ineffective bicep movement may occur.%目的 观察采用Oberlin手术(尺神经-肌皮神经肱二头肌肌支端端吻合)重建72例臂丛上干根性撕脱伤屈肘功能的远期疗效.方法 从2004年1月至2016年7月,臂丛上干根性撕脱伤72例行Oberlin手术(尺神经-肌皮神经肱二头肌肌支端端吻合),其中男50例,女22例,左侧35例,右侧37例,年龄8～52岁,平均34岁,损伤至接受手术时间3～9个月,平均5.5个月,随访时间共计142个月,平均3年7个月.所有的患者术前均行全面的体格检查、肌电图检查及颈椎MRI检查,以确定为臂丛上干根性撕脱伤(明确尺神经支配肌群肌力≥4级).72例患者中55例为C5-6根性撕脱伤,17例为C5-7根性撕脱伤.术后观察并评估患肢屈肘功能恢复情况及肱二头肌肌力测量(肌力测量使用British Medical Research Council评分系统(Mo～M5).结果 72例中完成随访62例(86.11％),7例失访(9.72％),3例因术中发现尺神经变异而放弃手术(4.17％).62例于末次随访时测定患肢肱二头肌肌力恢复情况,其中49例(79.03％)患肢肌力恢复≥M3,13例(20.97％)患肢肌力恢复＜M3.结论 Oberlin 手术治疗臂丛上干根性撕脱伤重建屈肘功能疗较为肯定,需注意的是手术时选择肌皮神经肱二头肌最大分支后与尺神经行端端吻合,否则可能出现术后肱二头肌无效活动.
