[锁骨上病变导致的成人臂丛神经C5 - C6及C5 - C6 - C7创伤性麻痹] - Suppr

Alnot J Y, Rostoucher P, Oberlin C, Touam C

Service de Chirurgie Orthopédique et Traumatologique, Hôpital Bichat, Paris.

Rev Chir Orthop Reparatrice Appar Mot. 1998 Apr;84(2):113-23.

PURPOSE OF THE STUDY

In C5-C6 and C5-C6-C7 brachial plexus palsies, prognoses was based on the recovery of a useful shoulder and elbow in order to control a normal or partially impaired hand. Treatment was an integrated procedure combining direct nerve surgery and muscle transfers.

MATERIAL

Our study was performed on 27 cases of C5-C6 plexus palsy and 43 cases of C5-C6-C7 plexus palsy operated between 1984 and 1994, with an average delay between trauma and surgery of 8 months.

METHODS

Elbow flexion was obtained by nerve surgery on the anterior part of the primary trunk or directly on the musculo-cutaneous nerve and after muscle transfer. Nerve surgery on supra-scapular nerve, on posterior part of primary trunk or directly on axillary nerve was also performed.

RESULTS

The results were analyzed separately for shoulder and elbow flexion and globally. In C5-C6 palsies, elbow flexion was a goal which has been reached in 100 per cent of cases. Only 56 per cent of cases obtained a stable shoulder with active external rotation. In C5-C6-C7 palsies, elbow flexion was reached in 86 per cent of cases and stable shoulder with active external rotation only in 26 per cent. Reinnervation of the elbow flexors was reached by direct nerve surgery in 60 per cent of C5-C6 and 52 per cent of C5-C6-C7. Active external rotation was reached by spinal-suprascapularis nerve neurotization in 60 per cent of C5-C6 and 54 per cent of C5-C6-C7.

DISCUSSION

No significant difference after nerve surgery for elbow flexion was found between C5-C6 and C5-C6-C7 plexus palsies. Failures of nerve surgery will undergo muscle transfer. When C7 is damaged, less muscles are transferable and results are less good. For shoulder, best results were obtained after spinal suprascapularis nerve neurotization with direct suture. In case of failure, a derotation osteotomy was performed. If shoulder was still unstable, transposition of the coracoacromial ligament to the humerus was also performed.

CONCLUSION

In C5-C6 palsies, elbow flexion is a goal which must be reached in 100 per cent of cases. Prognosis depends of shoulder function. In C5-C6-C7 palsies, results are less good. 6 patients did not recover elbow flexion, no active mobility of the shoulder was observed in 63 per cent of them. The results obtained for elbow flexion are satisfactory if the program does not separate nerve surgery and muscle transfers.

研究目的

在C5 - C6和C5 - C6 - C7臂丛神经麻痹中，预后取决于有用的肩部和肘部功能的恢复，以便控制正常或部分受损的手部。治疗是一种将直接神经手术和肌肉转移相结合的综合程序。

材料

我们的研究对1984年至1994年间接受手术的27例C5 - C6丛神经麻痹患者和43例C5 - C6 - C7丛神经麻痹患者进行，创伤与手术之间的平均间隔时间为8个月。

方法

通过对主要干的前部进行神经手术或直接对肌皮神经进行手术以及肌肉转移来实现肘部屈曲。还对肩胛上神经、主要干的后部或直接对腋神经进行了神经手术。

结果

分别对肩部和肘部屈曲以及整体结果进行了分析。在C5 - C6麻痹中，肘部屈曲是一个在100%的病例中都能实现的目标。只有56%的病例获得了具有主动外旋功能的稳定肩部。在C5 - C6 - C7麻痹中，86%的病例实现了肘部屈曲，只有26%的病例获得了具有主动外旋功能的稳定肩部。在C5 - C6病例中，60%通过直接神经手术实现了肘部屈肌的再支配，在C5 - C6 - C7病例中这一比例为52%。在C5 - C6病例中，60%通过脊髓 - 肩胛上神经神经移植实现了主动外旋，在C5 - C6 - C7病例中这一比例为54%。

讨论

C5 - C6和C5 - C6 - C7丛神经麻痹在肘部屈曲的神经手术后未发现显著差异。神经手术失败的患者将接受肌肉转移。当C7受损时，可转移的肌肉较少，效果也较差。对于肩部，通过直接缝合进行脊髓 - 肩胛上神经神经移植后获得了最佳效果。如果失败，则进行旋转截骨术。如果肩部仍然不稳定，还会进行喙肩韧带向肱骨的移位术。