Ochiai N, Nagano A, Sugioka H, Hara T
University of Tokyo, Japan.
J Bone Joint Surg Br. 1996 Sep;78(5):754-8.
We have assessed the efficacy of free nerve grafts in 90 cases of brachial plexus injury. Relatively good recovery of the elbow flexor and extensor muscles and of those of the shoulder girdle was found but recovery of the flexors and extensors of the forearm and of the intrinsic muscles of the hand was extremely poor. Poor results were found when spinal nerve roots seemed normal to the touch and appeared intact but had abnormal somatosensory evoked potentials or myelography. Recovery of the deltoid and infraspinatus muscles was better when injury had occurred to the circumflex and suprascapular nerves rather than to the plexus itself, perhaps because these nerves were explored in their entirety to determine the presence of multiple lesions. It is important to visualise the entire nerve thoroughly to assess the overall condition. Thorough exploration of the plexus and the use of intraoperative recording of somatosensory evoked potentials are essential.
我们评估了90例臂丛神经损伤患者中游离神经移植的疗效。发现肘屈肌和伸肌以及肩胛带肌肉恢复相对良好，但前臂屈肌和伸肌以及手部固有肌的恢复极差。当脊神经根触摸起来似乎正常且外观完整，但体感诱发电位或脊髓造影异常时，结果不佳。当损伤发生在旋肱后神经和肩胛上神经而非臂丛本身时，三角肌和冈下肌的恢复更好，这可能是因为对这些神经进行了全面探查以确定是否存在多处损伤。彻底可视化整条神经以评估整体状况很重要。对臂丛进行全面探查并术中记录体感诱发电位至关重要。
