Contralateral C7 Transfer to Lower Trunk Via a Subcutaneous Tunnel Across the Anterior Surface of Chest and Neck for Total Root Avulsion of the Brachial Plexus: A Preliminary Report
Contralateral C7 Transfer to Lower Trunk Via a Subcutaneous Tunnel Across the Anterior Surface of Chest and Neck for Total Root Avulsion of the Brachial Plexus: A Preliminary Report
复制标题
DOI：
10.1227/01.neu.0000369658.43380.95
复制
发表时间：
2010-06-01
期刊：
影响因子：
4.8
通讯作者：
Zhu, Yi
中科院分区：
文献类型：
--
作者：
Feng, Juntao;Wang, Tao;Zhu, Yi
目的：我们研究了一种创新和有效的手术方法，通过将对侧C7穿过胸部和颈部前表面的皮下隧道，恢复腕关节屈曲，手指屈曲和手部感觉。四名患者2005年11月至2007年7月收治全臂丛神经撕脱伤3例，男1例，女1例，年龄18 ~ 36岁（平均26岁）。手术延迟23天~ 5个月，平均2个月。采用健侧C7神经根经胸颈前皮下隧道修复损伤的下干或C8-T1脊神经。2例采用C8 ~ T1残根直接缝合。结果：术后26个月和38个月的肌电图检查均记录到小指展肌和拇长屈肌的复合肌肉动作电位和运动单位电位。临床检查指屈评分M1 ~ M3，腕屈评分M2 ~ M4，手感觉评分S1 ~ S3。结论：健侧C7移位至下干是安全可行的。与传统的健侧C7神经移位正中神经相比，该术式可使患者获得更好的屈腕、屈指和手部感觉恢复。
OBJECTIVE: We investigate an innovative and efficacious procedure for restoring wrist flexion, finger flexion, and hand sensation by passing the contralateral C7 through a subcutaneous tunnel across the anterior surface of the chest and neck.METHODS: Four patients (3 men, 1 woman) with total brachial plexus avulsion were treated from November 2005 to July 2007, their ages ranging from 18 to 36 years (average, 26 years). The operative delay was from 23 days to 5 months (mean, 2 months). The contralateral C7 nerve root was employed to repair the injured lower trunk or the C8-T1 spinal nerves via the subcutaneous tunnel across the anterior surface of the chest and neck. Direct neurorrhaphy was performed on the C8-T1 residual nerve roots in 2 patients. In the other 2 patients, a nerve graft of 4.5 cm in length was used to restore function of the affected lower trunk.RESULTS: Postoperative electromyography at 26 and 38 months recorded compound muscle action potentials and motor unit potentials in the abductor digiti minimi and the flexor pollicis longus in all cases. On clinical examination digital flexion scored M1-M3, carpal flexion M2-M4, and hand sensation S1-S3.CONCLUSION: Transfer of the contralateral C7 to the lower trunk proved to be a safe and feasible procedure. Compared with the traditional transfer of the contralateral C7 to the median nerve, it might help patients gain better restoration of wrist flexion, finger flexion, and hand sensation.