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目的探讨丛内外神经移位修复儿童臂丛损伤的疗效。方法本院收治的16例4个月～6岁臂丛损伤患儿,根据其臂丛根性撕脱伤程度、部位的不同,应用显微外科技术进行选择性丛内神经移植和丛外神经移位,利用动力神经源修复患侧正中神经、桡神经或肌皮神经等,同时手术前后指导患儿进行合理、积极的康复锻炼,以促进神经功能的尽快修复。结果所有患儿随访6～24个月,术后肌力得到不同程度的恢复,屈肘功能恢复有效率达93.8%(15/16例),其中优良率占75.0%(12/16例);三角肌肌力恢复3级者达25.0%(4/16例)、恢复2级者达38.0%(6/16例);伸肘曲腕肌力恢复有效率为75.0%(12/16例)。神经恢复以肌皮神经恢复效果最好,肱二头肌肌力3～4级;正中神经、桡神经支配肌力2～3级;腋神经恢复较差,支配肌力1～3级。结论早期诊断,早期合理手术,利用显微技术精确地吻合神经,并辅助手术前后康复锻炼是治疗儿童臂丛神经损伤的关键。
Objective To investigate the curative effect of brachial plexus injury in children with pedicle screw fixation. Methods Sixteen children with brachial plexus injury of 4 months to 6 years old were treated in our hospital. According to the extent and location of radical avulsion of brachial plexus, selective intra-brachial nerve graft and extra-brachial nerve transfer Bit, the use of motor nerve repair ipsilateral median nerve, radial nerve or musculocutaneous nerve, at the same time before and after surgery to guide children with reasonable and positive rehabilitation exercise to promote neurological repair as soon as possible. Results All patients were followed up for 6-24 months. The muscle strength recovered to different degrees after operation. The effective rate of elbow flexion recovery was 93.8% (15/16 cases). The excellent and good rate was 75.0% (12/16 cases). The strength of deltoid muscle recovered 3 grade 25.0% (4/16 cases), the recovery of 2 grade 38.0% (6/16 cases); elbow flexor wrist muscle strength recovery efficiency was 75.0% (12/16 cases) . Nerve recovery to the best of muscular nerve recovery, biceps muscle strength 3 to 4; median nerve, radial nerve innervation of 2 to 3; axillary nerve recovery is poor, dominate the muscle strength of 1 to 3. Conclusion Early diagnosis, early reasonable surgery, the use of microscopic techniques to accurately match the nerve, and assisted rehabilitation before and after surgery is the key to the treatment of brachial plexus injury in children.