Zou Lin, Cao Xuecheng, Li Jing, Liu Lifeng, Wang Pingshan, Cai Jinfang
Department of Orthopedics and Traumatic Surgery, General Hospital of Jinan Military Command of Chinese PLA, Jinan 250031, Shandong Province, China.
Department of Neurology, General Hospital of Jinan Military Command of Chinese PLA, Jinan 250031, Shandong Province, China.
Neural Regen Res. 2012 Jul 15;7(20):1545-55. doi: 10.3969/j.issn.1673-5374.2012.20.004.
Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C3-4 transfer for neurotization of C5-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 + phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level III-IV, scapular muscle to level III-IV, latissimus dorsi and pectoralis major muscles to above level III, and the brachial triceps muscle to level 0-III. Results showed that the improved C3-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.
对臂丛上干根性撕脱伤的实验大鼠采用改良的C3-4移位术进行C5-6神经转位治疗。结果显示，治疗后6个月时Terzis梳理试验评分显著提高，C5-6运动诱发电位潜伏期逐渐缩短，波幅逐渐增大。C3替代C5以及C4 + 膈神经替代C6的有髓神经纤维穿过吻合口的比例约为80%。有髓神经纤维排列松散，但髓鞘厚度与健侧相似。在临床应用中，对39例臂丛上干根性撕脱伤患者采用改良的C3替代C5神经根移位术及C4神经根加膈神经替代C6神经根移位术进行治疗，术后随访6个月至4.5年。结果显示，肱二头肌和三角肌肌力恢复至Ⅲ-Ⅳ级，肩胛肌恢复至Ⅲ-Ⅳ级，背阔肌和胸大肌恢复至Ⅲ级以上，肱三头肌恢复至0-Ⅲ级。结果表明，在动物模型中，改良的C3-4移位术治疗臂丛上干根性撕脱伤与临床结果相似，C3-4及膈神经移位用于C5-6神经转位可支配撕脱的臂丛上干，促进上肢神经功能恢复。
