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目的探讨臂丛神经瘤切除后,神经移植或移位术对产瘫患儿上肢功能的影响及变化规律,为该手术在临床推广提供依据。方法2 0 0 1年3月至2 0 0 2年4月,对49例早期产瘫患儿,采用臂丛神经瘤切除、神经移植或移位术修复臂丛神经。术后经1、3、12个月随访肩外展、屈肘、伸腕和伸掌指关节功能,用配对t检验比较手术前后患肢功能的差异。结果结合术前体检、术中各神经根探查及电生理检测结果,手术探查发现C5、6神经根以椎孔外断裂为主;C7神经根多为根性撕脱;C8、T1神经根常为轻度损伤(SunderlandⅡ度以下)或根性撕脱。术后1个月原已部分恢复的肩外展、屈肘、伸腕和伸掌指关节动作均丧失;术后3个月肩外展功能已优于术前,屈肘、伸腕和伸掌指关节功能恢复到术前水平;术后1年肩外展、屈肘、伸腕和伸掌指关节功能明显优于术前(P <0 .0 1)。结论对有早期手术探查指征的产瘫患儿,在切除创伤性神经瘤的同时修复臂丛神经,术后不会导致肢体原有功能的不可逆损害。
Objective To investigate the effects and changes of upper limb function in children with paraplegia after brachial plexus neuroblastoma resection, and to provide basis for its clinical application. Methods From March 2001 to April 2002, 49 cases of children with early-onset paralysis were treated with brachial plexus excision and brachial plexus repair with nerve grafting or displacement. The patients were followed up for shoulder abduction, elbow flexion, extensor phalanges and extensor digitated joint function at 1, 3, and 12 months after operation. The differences of limb function before and after operation were compared by paired t test. Results Combined with preoperative physical examination, intraoperative nerve root exploration and electrophysiological examination results, we found C5,6 nerve root fracture outside the foramen; C7 nerve root mostly root avulsion; C8, T1 nerve root often Mild injury (Sunderland degree below) or root avulsion. Shoulder abduction, elbow flexion, extensor phalanges and extensor digitorum metacarpophalangeal joints partially restored at one month postoperatively were lost. The function of shoulder abduction at 3 months postoperatively was superior to preoperative, elbow flexion, extensor wrist and extensor fingers The function of the joint recovered to preoperative level. The function of shoulder abduction, elbow flexion, extensor phalanges and extensor digitorum well one year after operation was significantly better than that before operation (P <0.01). Conclusion For children with paralysis who have indications of early surgical exploration, they can repair the brachial plexus nerve while removing traumatic neuroma, and will not cause irreversible damage to the original function of the limbs after operation.