摘要
背景:副神经移位修复肩胛上神经,常用于重建臂丛损伤患者的肩外展功能。但是副神经移位后对斜方肌的功能影响及岗上、下肌新生电位出现时间尚不清楚。目的:观察臂丛损伤患者在锁骨下水平切断副神经并移位到肩上神经后,其斜方肌不同部位的电生理改变。设计:以诊断为依据的自身对照的回顾性研究。地点和对象:实验地点为复旦大学华山医院手外科,实验对象:1996-01/2000-02进行副神经移位修复肩胛上神经的臂丛神经损伤患者,资料完整的20例作为研究对象。其中男17例,女3例;年龄11～46岁,平均29岁。方法:20例臂丛损伤患者伤后3～6个月,于锁骨下水平切断副神经移位到肩上神经。应用PHASIS电生理仪,在颈部胸锁乳突肌前放置刺激电极,在斜方肌上、中、下部及胸锁乳突肌进行记录,同时对术后岗上、下肌进行动态肌电检测及功能随访。主要观察指标:斜方肌术前、术后肌力检查,上、中、下动作电位波幅值、患肢外展功能。结果:在锁骨下水平切断副神经移位到肩上神经,对斜方肌下部功能影响明显,对中上部无明显影响。83.3%的患者术后5～9个月冈上肌可检测到神经再生电位,经术后2～3年随访此组患者均恢复了肩外展功能。结论:在锁骨下水平切断副神经移位后,主要影响斜方肌下部功能,对上、中部无明显影响。
BACKGROUND:Transferring accessory nerve to suprascapular nerve is regularly ad opted to reconstruct shoulder abduction of the patients with brachial plexus les ion.But it is not clarified yet if the function of trapezius will be interfered with and when the newborn potentials of supraspinatus and infraspinatus appear a fter the transferring procedure.OBJECTIVE:To investigate the pre-and postoperative electrophysiological chang es of the different sites of trapezius and its effect on the function of trapezi us of the patients with brachial plexus injury whose accessory nerves were secti oned at the infraclavicular level and transferred to suprascapular nerves during operation.DESIGN:An auto-control retrospective study was performed according to the dia gnosis. SETTING and PARTICIPANTS:The experiment was carried out in the Department of H and Surgery of Huashan Hospital,Fudan University. During January,1996 and Februa ry,2000,the accessory nerves of patients with brachial plexus injury were transf erred to suprascapular nerves,and 17 men and 3 women of these patients with full data,aged 11 to 46 years,with a mean age of 29 years old were selected as the s ubjects.METHODS:The accessory nerve of these 20 patients was sectioned at infraclavicu lar level and transferred to suprascapular nerve 3 to 6 months after injury.PHAS IS was used for electrophysiological examination.The stimulating electrode was p laced over the surface of sternocleidomastoid muscle, and the record was made at the upper, middle and lower part of trapezius muscle and sternocleidomastoid mu scle.The dynamic EMG and functional following-up were carried out at the supras pinatus and infraspinatus postoperatively.MAIN OUTCOME MEASUREMENTS:The testing of muscle strength before and after oper ation was performed,and the amplitude values of action potential of the upper,mi ddle and lower part of trapezius muscle,and the abduction of affected extremity were measured.RESULTS:Sectioning and transferring of accessory nerve at infraclavicular leve l disturbed the function of the lower part of trapezius muscle obviously,while t here was no significant effect on the upper and middle parts.The neural regenera tion action potential of supraspinatus of 83.8% patients was detected 5-9 mon ths after operation.All the patients in this group regained their function of sh oulder abduction 2-3 years later.CONCLUSION:Sectioning accessory nerve at the infraclavicular level would inter fere with the function of the lower part of trapezius muscle.If sternocleidomast oid muscle possesses good function, the proximal accessory nerve close to the br anch innervating the sternocleidomastoid muscle can still be selected as a donor nerve in spite of the severe paralysis of trapezius muscle.
出处
《中国临床康复》
CSCD
2004年第11期2136-2138,共3页
Chinese Journal of Clinical Rehabilitation
基金
上海市科委资助课题(97419031)~~
