关键词: 臂丛损伤, 残根利用, 动力源神经, 上干

Abstract:

Objective To analyze and compare the clinical effects of upper brachial plexus repair with nerve root stumps and each type of power source nerves， determine the availability of nerve root stumps and the effectiveness and rationality of clinical use. Methods Retrospective analysis was performed for the patients admitted to our department from January 2007 to December 2015. The patients were diagnosed with partial or total brachial plexus injury. Case data were collected including gender， age，diagnosis， cause of injury， interval between injury and operation， follow-up time， injury type， operation method， gap length between donor and recipient nerve， graft type and length， and complications. In addition， we also examine the adverse events in the donor site. The British Medical Research Council （BMRC） muscle strength evaluation criteria were used to evaluate the patients' deltoid muscle and biceps muscle strength and we also performed disabilities of arm， shoulder and hand （DASH） score. Results A total of 136 patients received brachial plexus repair， 112 cases included in the study after 24 cases were excluded. The patients were divided into four groups： 22 cases in modified Oberlin surgery group， 45 cases in CC7 transfer comebined with huamn acellular nerve allograft group， 27 cases in CC7 transfer and direct suture group. There were 14 cases of nerve root stumps repair upper trunk directly or combined with huamn acellular nerve allografting， which including 10 cases of BPAI and 4 cases of stab wound. The effective rate of deltoid muscle strength was 68.2%， 71.2%， 88.9% and 78.6%， respectively. The muscle strength and effective rate of biceps were 81.8%， 60.0%， 85.2% and 64.3%， respectively. Subgroup analysis： （1） operative methods for upper brachial plexus injuries： 4 cases with stab wounds in the nerve root stump repair group； in the modified Oberlin surgery group， 22 cases were avulsion injury. The results showed that there were no statistically significant differences between the two groups in the ROM， deltoid muscle strength， biceps muscle strength and DASH score. For the comparison of C5-C8 or TBAI： there is no statistical difference in ROM of shoulder abduction between the nerve root stump repair group and CC7 transfer and direct suture group； the evaluation indexes include angle of elbow flexion， biceps muscle strength and DASH score in CC7 transfer and direct suture group were better than the other two groups， followed by CC7 transfer combined with shenqiao group and nerve root stump repair group. Conclusions This part evaluated and analyzed the clinical effects of various kinds of power sources nerve on the recovery of elbow flexion and shoulder abduction after upper brachial plexus repairing， and determined the availability of nerve root stump and the validity and rationality of its clinical use. Protecting the nerve stump roots may improve the clinical effect of nerve stump utilization and increase the power source nerve in the future.

Key words: brachial plexus injury, nerve root stumps utilization, power source nerres, upper trunk