经椎体前路健侧颈7神经移位术治疗中枢性上肢痉挛性瘫痪的解剖学研究与临床应用

doi:10.3760/cma.j.cn101201-20210513-00129

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摘要目的解剖观察经椎体前路C₇神经移位术中C₇神经的定位、走行及长度等相关解剖特征;探讨椎体前路健侧C₇神经移位术治疗中枢性上肢痉挛性瘫痪的可行性、安全性及临床疗效。方法（1）选取4具新鲜冰冻成人尸体头颈部标本,其中男2具、女2具,年龄46~72岁（平均59岁）。模拟椎体前路C₇神经移位术,显微镜下游离C₇神经近端椎间孔处至远端神经分叉处,测量C₇神经与锁骨内侧缘垂直距离、C₇神经长度以及椎体前路C₇神经移位的最短距离。（2）回顾性分析2019年11月—2020年12月江苏省苏北人民医院2例脑出血术后中枢性上肢痉挛性瘫痪患者的临床资料。患者均为女性,年龄分别为50岁和51岁,患侧上肢瘫痪,肌力分别为0级和1级,肌张力均较高。2例患者均采用椎体前路健侧C₇神经移位手术治疗,观察患者上肢感觉与运动功能、上肢肌力和肌张力恢复情况,以及手术并发症情况。结果（1）经椎体前路可充分显露和定位两侧C₇神经,C₇神经走行于前斜角肌与中斜角肌之间,C₇神经与锁骨内侧缘垂直距离1.7~2.5（2.1±0.3）cm,C₇神经长度5.6~6.8（6.4±0.5）cm,椎体前路C₇神经移位的最短距离4.8~5.7（5.3±0.4 cm）。（2）2例中枢性上肢瘫痪患者均顺利完成椎体前路健侧C₇神经移位手术。2例患者术后健侧上肢运动功能均正常,健侧上肢出现疼痛和麻木感,均在1个月恢复。2例患者患侧上肢痉挛症状均得到明显缓解,其中1例患者随访12个月,末次随访时患侧上肢感觉正常,近端肌力3级、远端肌力2级;另1例患者随访8个月,末次随访时患侧上肢感觉正常,近端肌力1级、远端肌力0级。2例患者均未见切口感染、健侧上肢肌力减退等并发症发生。结论对于中枢性上肢痉挛性瘫痪,经椎体前路健侧C₇神经移位术治疗安全、可行,是一种较好的选择。

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	严正村
	恒柱
	顾加祥
	刘宏君
	孟兆祥
	罗文苗
	王晓东
	王杏东
	魏民

关键词 ：神经移位, 颈7神经, 椎体前路, 中枢性上肢痉挛性瘫痪, 应用解剖学

Abstract：Objective To observe the anatomical characteristics of cervical 7 (C₇) nerve location, route and length during anterior vertebral C₇ never transposition, and to observe the safety and clinical effect of contralateral C₇ nerve transfer surgery through the anterior vertebral pathway. Methods (1) Four fresh head and neck anatomical specimens, including two males and two females aged 46-72 years with an average of 59 years, were selected. Contralateral C₇ nerve transfer surgery was simulated through the anterior vertebral pathway. The C₇ nerve from the proximal intervertebral foramen to the distal bifurcation was separated. The vertical distance between the C₇ nerve and the medial edge of the clavicle and the length of the C₇ nerve were measured. The end of the C₇ nerve was cut for standby. The same procedure was performed on the C₇ nerve on the other side. The anterior vertebral space was separated until both sides were connected. The distal end of one C₇ nerve root was transferred through the anterior vertebral space and sutured to the distal end of the other C₇ nerve. The shortest anterior C₇ nerve transfer was measured. (2) The clinical data of 2 patients with central upper limb spastic paralysis after intracerebral hemorrhage in North Jiangsu People's Hospital from November 2019 to December 2020 were retrospectively analyzed. The patients were female, aged 50 years and 51 years, with upper limb paralysis on the affected side, muscle strength of grade 0 and grade 1 respectively, and high muscle tone. Both patients were treated with anterior vertebral canal C₇ nerve transposition on the healthy side. Patients sensory and motor functions of the upper limbs, recovery of muscle strength and tension of the upper limbs and surgical complications were observated. Results (1) The bilateral C₇ nerve was fully exposed and located through the anterior approach of the vertebral body. The C₇ nerve ran between the anterior scalene muscle and middle scalene muscle. The vertical distance between the C₇ nerve and the medial edge of the clavicle was 1.7-2.5 (2.1 ± 0.3) cm, the length of the C₇ nerve trunk was 5.6-6.8 (6.4 ± 0.5) cm, and the shortest C₇ nerve meridian displacement through the anterior vertebral pathway was 4.8-5.7 (5.3 ± 0.4) cm. (2) Two patients with central upper limb paralysis received C₇ nerve transfer surgery via the anterior vertebral pathway. After the operation, the motor function of the healthy side of the patient returned to normal, pain and numbness in the healthy side of the upper limb improved within 1 month, and the spasm symptoms of the affected side of the two patients were remarkably relieved. One patient was followed up for 12 months. At the last follow-up, the upper limb of the affected side felt normal, the proximal muscle strength was grade 3, and the distal muscle strength recovered to grade 2. Another patient was followed up for 8 months. The patient's proximal and distal muscle strengths were grades 1 and 0, respectively. There were no complications such as incision infection and impaired muscle strength of the healthy side in a patients. Conclusion The C₇ nerve is a safe, feasible and a better choice for central upper limb spastic paralysis and anterior C₇ nerve transfer on the healthy side of the vertebral body.

Key words： Nerve transfer Cervical 7 nerve Anterior vertebral pathway Central upper limb spastic paralysis Applied anatomy

收稿日期: 2021-05-13

通讯作者: 张恒柱,Email：zhanghengzhu@sina.com

引用本文:

严正村, 恒柱, 顾加祥, 刘宏君, 孟兆祥, 罗文苗, 王晓东, 王杏东, 魏民. 经椎体前路健侧颈7神经移位术治疗中枢性上肢痉挛性瘫痪的解剖学研究与临床应用[J]. 中华解剖与临床杂志, 2022, 27(2): 70-75.
Yan Zhengcun, Zhang Hengzhu, Gu Jiaxiang, Liu Hongjun, Meng Zhaoxiang, Luo Wenmiao, Wang Xiaodong, Wang Xingdong, Wei Min. Anatomical study and clinical application of contralateral cervical 7 nerve transfer surgery through anterior vertebral pathway in the treatment of central upper limb spastic paralysis. Chinese Journal of Anatomy and Clinics, 2022, 27(2): 70-75.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101201-20210513-00129 或 http://www.cjac.com.cn/CN/Y2022/V27/I2/70

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