摘要目的:探讨采用改良健侧颈 7移位术治疗伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤的临床疗效。 方法:自2017年10月至2019年10月，我院对16例伴有膈神经、副神经损伤的全臂丛神经根性撕脱伤患者，行改良健侧颈 7移位术。手术分两期进行：Ⅰ期，将健侧颈 7前股外侧束经游离桡神经浅支移植修复患侧上干前股；将健侧颈 7后股的一束纤维，经尺神经手背支游离移植修复患侧肩胛上神经；健侧颈 7后股大部与带血供的患侧尺神经远端缝合。Ⅱ期：患侧尺神经远端移位正中神经远端。 结果:16例患者随访20~45个月，平均32个月。依据顾玉东臂丛神经损伤修复后功能评定标准：冈上、下肌肌力恢复达M 3及以上8例，M 2 6例，M 0~M 2 2例。肱二头肌肌力M 3及以上11例，M 2 5例。屈腕、屈指肌力M 3及以上9例，M 2~M 1 7例。正中神经支配区皮肤感觉恢复达S 3 6例，S 2~S 1 10例。 结论:对伴有膈神经、副神经损伤的全臂丛根性撕脱伤患者行改良健侧颈 7移位术，可以充分发挥健侧颈 7的动力储备，取得满意的临床疗效。

abstractsObjective:To investigate the clinical efficacy of modified contralateral C 7 transfer in the treatment of total brachial plexus root avulsion injury with phrenic nerve and accessory nerve injury. Methods:From October 2017 to October 2019, 16 patients with total brachial plexus root avulsion injury with phrenic nerve and accessory nerve injury were treated with modified contralateral C 7 transfer in our hospital. The operation was carried out in two stages: stage Ⅰ, the lateral bundle of anterior thigh of contralateral C 7 was transplanted to repair the anterior thigh of the upper trunk on the affected side through the free superficial branch of radial nerve. The suprascapular nerve of the affected side was repaired by free transplantation of a bundle of fibers from the posterior thigh of contralateral C 7 through the dorsal branch of ulnar nerve. Most of the posterior thigh of contralateral C 7 was sutured to the distal end of the ulnar nerve with blood supply. Stage Ⅱ, the distal ulnar nerve of the affected side was transferred to the distal median nerve. Results:All the 16 patients were follow-up for 20 to 45 months, with an average of 32 months. According to Gu Yudong′s functional evaluation criteria after repair of brachial plexus injury, the strength of supraspinatus muscle and infraspinatus muscle recovered to M 3 and above in 8 cases, M 2 in 6 cases, and M 0 to M 2 in 2 cases. The strength of biceps brachii muscle recovered to M 3 and above in 11 cases, M 2 in 5 cases. The strength of wrist and finger flexion recovered to M 3 and above in 9 cases, M 2 to M 1 in 7 cases. The skin sensory recovery in the median innervated area reached S 3 in 6 cases and S 2 to S 1 in 10 cases. Conclusion:The modified contralateral C 7 transfer in patients with total brachial plexus root avulsion injury accompanied by phrenic nerve and accessory nerve injury can give full play to the dynamic reserve of contralateral C 7 and achieve satisfactory clinical efficacy.