Samardzić M, Grujicić D, Rasulić L, Milicić B
Institute of Neurosurgery, Clinical Center of Serbia, Belgrade, Yugoslavia.
Acta Neurochir (Wien). 2002 Apr;144(4):327-34; discussion 334-5. doi: 10.1007/s007010200045.
Restoration of upper arm function presents the main priority in nerve repair of brachial plexus traction injuries. The results are predominantly influenced by the level and extent of injury, and the type of surgical procedure. The purpose of this study is to evaluate influence of these factors on final outcome.
Study included 91 surgically treated patients, including 71 patients with avulsions of one or more spinal nerve roots and 20 with peripheral traction injuries. We performed 120 nerve transfers, 25 nerve graftings and 29 neurolyses on different nerve elements depending on the type of nerve damage. Analysis of motor recovery for elbow flexion and arm abduction, isolated or in combination, was done.
Recovery of elbow flexion was obtained in 75% nerve transfers, and in 68,7% nerve graftings in peripheral traction injuries. Recovery of arm abduction was obtained in 78,5% nerve transfers, and in 44,4% nerve graftings in peripheral traction injuries. Neurolysis was successful in all cases. Generally, the quality of recovery was better for the musculocutaneous nerve. Useful global upper arm function was obtained in 49,3% of patients with avulsion of spinal nerve roots, and in 55% of patients with peripheral traction injuries.
Regarding upper arm function the prognosis of surgically treated patients with traction injuries to the brachial plexus is generally similar in cases with central or peripheral level of injury. However, nerve transfers of collateral branches seem to be superior to nerve grafting and may be another possibility for repair in cases with extensive nerve gaps.
恢复上臂功能是臂丛神经牵拉伤神经修复的主要重点。结果主要受损伤的水平和范围以及手术方式的影响。本研究的目的是评估这些因素对最终结果的影响。
研究纳入91例接受手术治疗的患者，包括71例一根或多根脊神经根撕脱伤患者和20例周围牵拉伤患者。根据神经损伤类型，我们对不同神经元件进行了120次神经移位、25次神经移植和29次神经松解术。对单独或联合的肘屈曲和上臂外展的运动恢复情况进行了分析。
在周围牵拉伤中，75%的神经移位和68.7%的神经移植实现了肘屈曲恢复。在周围牵拉伤中，78.5%的神经移位和44.4%的神经移植实现了上臂外展恢复。所有病例的神经松解术均成功。一般来说，肌皮神经的恢复质量更好。49.3%的脊神经根撕脱伤患者和55%的周围牵拉伤患者获得了有用的整体上臂功能。
关于上臂功能，臂丛神经牵拉伤手术治疗患者在中枢或周围损伤水平的预后通常相似。然而，侧支神经移位似乎优于神经移植，对于存在广泛神经间隙的病例可能是另一种修复选择。
