Akasaka Y, Hara T, Takahashi M
Department of Orthopaedic Surgery, Tokyo Seamen's Insurance Hospital, Japan.
Microsurgery. 1991;12(5):346-51. doi: 10.1002/micr.1920120506.
Complete paralysis due to traumatic brachial plexus injury is extremely difficult to treat when the injury affects whole nerve roots and when motor function fails to show any signs of recovery. Seddon has suggested that arthrodesis of the shoulder and amputation at the humerus, combined with the use of a functional upper extremity prosthesis, was the most practical procedure available. Since 1965, in cases of irreparable lesions such as complete root avulsion type injuries, we have performed direct intercostal nerve crossing to the musculocutaneous nerve without free nerve graft to achieve elbow flexion. However, it is necessary to operate on the patient within 6 months following the injury to obtain good results. In the past there was no procedure for dealing with delayed cases of complete brachial plexus palsy. However, with the advent of microsurgical techniques, new approaches have become open to us. Since 1978, we have reconstructed the elbow flexor by the combined surgery of free muscle transplantation with intercostal nerve crossing in delayed cases of complete paralysis. This article introduces the operative technique and the results we have obtained.
当创伤性臂丛神经损伤累及整个神经根且运动功能未显示任何恢复迹象时，因该损伤导致的完全性瘫痪极难治疗。西登曾提出，肩关节融合术和肱骨截肢术，再结合使用功能性上肢假肢，是可行的最实际的手术方法。自1965年以来，对于诸如完全性神经根撕脱伤等不可修复的损伤病例，我们已实施直接肋间神经与肌皮神经交叉术，而无需游离神经移植来实现屈肘。然而，有必要在损伤后6个月内对患者进行手术以获得良好效果。过去，对于完全性臂丛神经麻痹的延迟病例没有处理方法。然而，随着显微外科技术的出现，我们有了新的治疗方法。自1978年以来，我们在完全性瘫痪的延迟病例中通过游离肌肉移植与肋间神经交叉的联合手术重建了屈肘功能。本文介绍了手术技术及我们所取得的结果。
