TAP CHl Y DU'Q'C L A M S A N G 108 Tgp 10 - So 2 /2015
Danh gia do an toan va hieu qua cua ky thuat chuyen toan bo r i C7 ben lanh vol doan ghep than kinh tru gap doi CO mach nuoi trong dilu tri nh6, dirt toan bo cac re than kinh dam roi than kinh canh tay
Safety and efficacy of total contralateral C7 transfer with vascularized folded ulnar nerve graft in repair of total brachial plexus root avulsion and rupture
Nguyin Viet Ti6n, Nguygn Vik Ngoc, Benh vien Trung uang Qudn dgi 108 Cha Dinh Nghia
Tom tat
/ W u c t / e u . - D a n h g i a d p a n t o a n v a hieu qua ky t h u a t chuyen re C7 ben lanh cho than kmh c o b i v a t h a n kinh glUa vdi hai doan ghep la than kinh tru eo mach nuoi qua d u d n g ham dUdi xUong d o n va trUde khi quan t r o n g dieu trj t o n t h u o n g dam roi canh tay. Doi tdgng vd phdong phdp: 110 benh nhan bj t o n t h u o n g dam roi canh tay do nho, d u t toan bo eac re duoc chuyen toan bp re C7 ben lanh cho t h a n kinh CO bi va t h a n kinh giUa. Co hai thay doi ky thuat: Mot Id, than kinh ghep duoe luon qua d u d n g ham sau xUong d o n va trudc k h i q u a n . Ha//d, sCf d u n g 2 doan ghep than kinh tru eo mach nuoi. Danh gia ket qua phuc hoi eua t h a n kinh nhan theo BMRC./<er qud; 2 benh nhan bl liet than kinh hoanh nhUng t u phuc hoi.
Phuc hoi gap khuyu, gap co tay va cac ngon tay dat > MS lan luot la 88,2%, 29% va 2 1 % , phuc hoi e^m giac d ban tay m U e > S 2 la 95,4% so benh nhan./Cet/udn: Chuyen toan bp reC7 ben lanh vdi doan ghep la than kinh tru gap doi co maeh nuoi qua d u d n g ham sau xUOng don va trUdc khi quan t r o n g dieu tri t o n t h u o n g dam roi canh tay la an toan, lam giam do dai than kinh ghep, ket qua phuc hoi cua than kinh nhan la khci quan.
Tdkhda: Chuyen C7, t o n t h u o n g dam roi canh tay.
Summary
Objective: To assess t h e safety and efficacy of total contralateral C7 transfer w i t h vascularized folded ulnar nerve graft passed t h r o u g h the subclavicular and pretracheal tunnel in repair of total brachial plexus root avulsion and rwptuxe. Subject and method: 110 patients wflth brachial plexus injury due t o total root avulsion and rupture were treated w i t h total contralateral C7 transfer t o the musculocutaneous and median nerves. There were some changes in surgical techniques: 1. the nerve grafts were passed t h r o u g h the subclavicular and pretracheal tunnel; 2. The vascularized folded ulnar nerve graft were used. Result Two patients had a complication of temporary phrenic nerve palsy. The motor recovery of elbow, wrist and finger flexors reached >IV13 In88.2%, 29% and 2 1 % of patients, respectively. Sensory recovery on t h e
Phan bi?n khoa h^c: PGS.TS. LE VAN DOAN
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol1O-N°2/20|
hand reached s S2 in 95.4%. Conclusion: The total contralateral C7 transfer w i t h vascularized folded ulnai,, nerve graft passed t h r o u g h t h e subclavicular and pretracheal t u n n e l t o repair total brachial plexus im avulsion and rupture was a safe surgery and could help t o reduce t h e l e n g t h o f nerve g r a f t s . ' I '
functional recovery of t h e recipient nerves was satisfactory. ^ Keywords: Contralateral C7 transfer, brachial plexus injury. . |
1 . D a t v a n d e
Chuyen re C7 ben lanh eho than kinh (TK) co bi va TK giUa dUOc Gu [4] thUc hien nam 1986 qua doan ghep la TK tru co maeh nuoi di qua dUdng ham cheo trudc ngUc. Hien nay, phau thuat nay dupe xem la mpt trong nhUng phUdng phap chinh trong dieu trj nho cac re DRCT va dugc thuc hien pho bien tren the gidi.
Tai Benh vien T U Q E I 108, tU 7/2006 den nay, chung toi thUe hien ehuyen re C7 ben lanh vdi 2 doan ghep la TK tru gap doi c6 maeh nuoi di qua d u d n g ham dUdi xUdng don va trUde khi qu^n eho TK CO bl va TK giUa de dleu trj t o n t h u o n g noi tren.
Trong bao eao nay, chung toi trinh bay ve dp an t o a n va hieu quci eUa ky thuat nay.
2 . D o i t U t f n g va phUcfng p h a p
Doi ti/ipig: 110 benh nhan (BN) bj t d n t h u o n g DRCT do nho, dUt toan bp eac re d vung trUde hach hoac sat 16 ghep d o t song dugc phau thuat tU 7 / 2 0 0 6 - 9 / 2 0 1 3 .
Tieu chuan Ida chon BN:
BN duoc chan doan nho, dUt tat ca cae re DRCT dua vao kham lam sang, chup MRI, CT-myelography) va dien cd, dien TK. Thdi gian tU khi t o n t h u o n g den khi ddgc mo < 6 t h a n g . BN < 60 t u o i . Cac khdp vai, k h u ^ u , CO tay va cac khdp d n g d n tay ben liet van d o n g t h u d p n g b i n h t h u d n g . Khong cd t o n t h u o n g d u n g dap, xo hda nang eac eo nhj dau va cae ca khu t r u d c t r o n g cang tay. Du eac dieu kien cho phep gay me qua noi khi quSn va thUc hien phau t h u a t keo dai.
Tiiu chuan loai trd: Khong du cac tieu ehi nhU lUa chon.
Phddng phdp: Tlen cufu t h e o phUdng p ^ : quan sat m d tci, phan tich lam sang, theo doi d|£f
khong n h d m chu'ng. (^
Quy trinh ky thudt:
- Bddc 1. Kiem tra vd ddnh gid ton thddng:^
n^m ngQa, rach da dai 5 - 6 cm doe b d sau ca^- d o n - c h u m ben t o n thUdng, phau tich vao tam gilt CO sau. Bdc 16 va bao ve d o n g mach (DM) eo ngang.
Kiem tra cac re TK cua DRCT, khi t o n thuong la nho hoac dUt sat 16 g h e p tat ca cac re DRCT thi quyk d m h chi d j n h chuyen re C7 ben lanh. Boc tinh madr (TM) CO n d n g hoac nhanh cua nd (neu cd).
- Bddc 2. Bgc 16 re C7 Idnh ben lanh: Rach da dai 4 - 5 cm theo dUdng ngang, song song va tren xiiong ddn khoang 2 em, bat dau td b d sau cd dc-don- chum tdi t i n h mach co nong. Qua Idp da, to chiic dudi da va c o b a m da eo, taeh dpc theo b d sau cOiJc - don - chum de vao tam giac co sau. Tiep theo, bpc 16 du tat cac cae re TK cua DRCT de xae dinh re C7.
- Bddc 3. Tao dddng hdm trddc khi gudn: Phau tich tao m p t d u d n g ham giUa ldp can d sat mat tren cd vai m d n g va dUdi cd Uc - d d n - c h u m , dl qua phia trudc khi quan tai v u n g nen co sang ben doi di^n.
Thuc hien thao tac t u o n g t u tU ben doi dien de hai d u d n g ham nay t h d n g nhau va dat chi chd.
- Bddc 4. Bgc Id TK ca bl vd TK gida trong ho ndch ben ton thdong: Rach da chU 5, t d thanh trUdc n^ch qua b d dudi co ngUc Idn den ho nach va tdi 1/3 tren d n g canh tay. Bpc Id eac thanh phan trong ong canh tay, phau tich len cao t r o n g ho nach, tach TK ccf bi, TK giUa va TK t r u . Neu TK co bl tach t d cao thi m6 thanh trUdc nach dpc theo cd ngUc ldn, vao ho nach d e t i m T K e o b i .
- Bddc 5. Tao dddng hdm sau xdang don td ho ndch len vung tam gide co sau d bin ton thdong: Phau tich tao d u d n g ham tU ho nach, di sat b d ngoai cOa
TAP CHi Y DUO'C L A M S A N G 108 Tap 10-So 2/2015
bd ngoai, sau xUdng d d n len v u n g tam giac co sau.
Tach rong dUdng ham va dat ehi chd.
- Bddc 6. Lay TK tru ben ton thdong Idm dogn ghep: Dudi ga rd sat nach, rach da zic zSc doe theo d u d n g dl eua TK t r u , t d naeh tdi eo tay. Phau tich lay bo mach tru dl c u n g TK t r u . CSt dau dudi TK t r u sat ong Guyon, g o m ca nhanh cam giac mu tay cua TK tru. Tiep tue bdc tach TK tru len eao sat ga r6. Sau do, dat dan luu hut v u n g cang tay, canh tay va d d n g vet mo 2 ldp, bang vet mo cang tay va canh tay bSng bang gae v 6 khuan. Tiep theo, thao ga ro va bdc tach TK tru t d i sat nguyen uy. Taeh bao ngoai va e^t TK t r u sat nguyen uy sao cho khdng gay t o n t h u o n g maeh di vao nudi TK d v u n g nay.
- Bddc 7. Luon dogn ghep TK tru qua dddng hdm vd noi dong mgch tru vda dgng mgch co ngang, noi cac moi noi TKbang ky thuat vi phdu:
-I- Luon dau ngoai vl TK t r u qua dUdng ham sau xUdng ddn len v u n g eo ben t o n t h u o n g . Noi dau trung t a m cua DIVI t r u vao dau t r u n g tam cua D M co ngang, ndi TM t r y vao nhanh TM ndng (neu ed) hoac noi tan - ben vao TM co n o n g . Doan ghep TK t r u dupe gap ddi, luon dau gap ddi qua d u d n g ham trUdc khi quan, luon dau ngoai vi qua dUdng ham sau xUong d d n xuong v u n g ho naeh.
-I- Cat re C7 ben lanh, vi phau tich de taeh doi re C7 t h e o chieu t r u d c sau thanh nUa t r o n g va nUa ngoai. M d dpc va tach bao day TK t r u tren doan dai 3 em tal v u n g gap d o i , cat ddi TK tru va noi hai dau nay vao hai nda re C7 vdi cac m u i khau bao bd sdi TK b I n g chi 9/0. Ndi dau t r u n g t a m TK t r u vao TK co bi, dau ngoai vl TK t r u vao TK glUa.
-I- D d n g cae v e t m o 2 Idp. Khi d d n g vet mo v u n g CO ben t o n t h u o n g , chu y dat m o i noi D M t r u vdi D M c6 n g a n g ngay d u d i dUdng khau da de t h e o ddi sU luu t h d n g cua D M b I n g o n g nghe sieu am Doppler.
Ti^u chuan ddnh gid ket qud:
- Ket quh phuc hoi chdc nang cua TK nhan: Theo eac chi tieu cCia Hdi d o n g nghien eUu Y hpc Anh (British Medical Research Council) [5].
- NhUng tal bien, bien chdng t r o n g mo va giai doan hau phau.
3. Ket q u ^
- Dp dai dogn TK ghep (do d47 BN):
D p dai doan TK ghep t d C7 ben ianh cho TK giUa la 24,1 ± 1,6 em (21 - 27 cm) va cho TK eO bi la 22,7 ± 1,5 em (20 - 25 cm), sU khac biet nay khdng cd y nghia (p>0,05).
- Sd phuc hoi ciJaTKcc/bi: Co 110 BN dupe theo ddi > 18 thang.
Biing 1 . Phuc hoi gap khu^u sau chuyen re C7 ben lanh {n = 110)
1 8 - 3 6 thang
3 6 - 6 0 thang
> 6 0 t h a n g
Tongcong n
% theo hang
n
% theo hang
n
% theo hang
n
% theo hang
Phuc hoi gap khuyu MO
1
2,9
0 0
2
4,7
3
2,7 M l - 2
4
11,7
2
6,5
4
9,3
10
9,1 M3
16
47,1
8
25,8
6 14
30
27,3 M4
13
38,3
23 67,7
31 72,1
67
60,9 Tong cong 34
100
33
100
43
100
110
100
Being 1 cho thay t i le phuc hdi gap khuyu > MB la 88,2%. Test Likekihood Ratio va Chi - Square test eho thay ket quci giUa 3 n h d m cd sU khac biet (p = 0,046). Khi so sanh ket qua glUa n h d m 36 - 60 thang va > 60 thang thi khdng khac biet (p = 0,53).
N h u vay, phuc hdi gap khuyu se on d m h sau 3 - 5 nam.
SU phuc hoi cua TKgida: 76 BN co t h d i gian sau m d > 36 thang, ket qua phuc h6i TK giUa dugc trinh bay t r o n g bang 2, b^ng 3, bang 4,
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
B i n g 2. Phuc hoi gap co t a y (n = 76)
3 6 - 6 0 thang
> 60 thang
Tdng n
% theo hang n
% theo hang n
% theo hdng
Phuc hoi gap co tay MO
3 9,1
0 0 3 3,9
M1 7 21,2
4 9,3 11 14,5
H\2 11 33,3
21 48,8
32 42,1
IVI3 9 27,3
14 32,6
23 30,3
IM 3 9,1
4 9,3
7 9,2
Vol10-N°2/a(S
Tong 33 100 43 100 76 100
Bang 2 cho thay ti le phuc hoi gap co tay > M3 la 39,5%. Ket qua giOa nhom 36 - 60 thang va > 60 tliang la khong khac biet (p>0,05).
Bilng 3. Phuc hoi gap cac ngon tay Hit (n = 76)
3 6 - 6 0 thang
> 60 thang
Tong n
% theo hang n
% theo hang n
% theo hdng
Phuc hoi gap ngon MO
6 18,2
2 4,7 8 70,5
M l 13 39,4
10 23,3
23 30,3
M2 9 27,3
16 37,2
25 32,9
M3 5 15,2
13 30,2
18 23,7
M4 0 0 2 4,7
2 2,6
Tong
33 100 43 100
76 100
p>0,IJ5
Bang 3 eho thay ti le phuc hoi gap cae ngdn > M3 la 26,3%. Test Khi binh phUdng cho thay su khac biet khdng cd y nghia thong ke glUa hai nhdm.
Bang 4. Phuc hoi cam giac ban tay (n = 76)
3 6 - 6 0 thang
> 60 thang
Tong
% theo hang n
% theo hang n
% theo bang
Phuc hoi cdm giac SI
3 9,1%
2 4,7%
5 6,6
S2 10 30,3%
9 20,9%
79 25
S2-I- 11 33,3%
16 37,2%
27 35,5
S3 9 27,3%
16 37,2%
25 32,9
Tong 33 100%
43 100%
76 100
p=0,605
TAP CHi Y DU'O'C L A M S A N G 108 T9P 1 0 - S o 2/2015
Bang 4 eho thay 100% BN sau m d > 36 thang deu phuc hdi cam giac d mUe > 51. Trong dd, 95,4% BN dat mdc > 52 (ngudng cam giac bao ve). Ti le phuc hoi cam giae gida hai n h d m khdng khac biet (p>0,05).
Tai bien, bien chdng
- Tu mau v u n g co ben ton t h u o n g : 1 BN, dUde x d t r i m d lay mau t u , vet mo lien ky dau.
- Liet TK hoanh: 2 BN. Trong d o , ed 1 BN liet thoang qua, phuc hdi sau 3 ngay, BN nay khdng phcii t h d may ho t r d . 0 BN t h U 2, cd suy hd hap nen phSl t h d may ho t r g t r o n g 10 ngay.
4. Ban luan
Phau t h u a t ehuyen re C7 ben lanh qua doan ghep TK tru dao chieu cd mach nudi dua tren D M ben t r o n g t r u tren dUdc Gu [4] m d ta nam 1986.
Trong ky t h u a t nay, doan ghep dUde luon qua d u d n g ham dUdi da thanh ngue trUdc roi v o n g qua phia tren xUong d d n tdi nen co ben lanh, dau ngoai VI cua TK tru dUOc ndi vdi dau t r u n g tam cua re C7, dau t r u n g t a m duoe ndi vdi TK nhan. Day la ky t h u a t dang d U d c a p d u n g rong rai tren the gidi [6], [9].
Chieu dai d u d n g ham dudi da trUde thanh ngUc tU ben liet sang co ben lanh d ngUdi chau A t r o n g nghien eUu cua Waikakul [9] la 43,5 c m , cua Chuang [2] la 40 cm, d ngUdi da t r ^ n g t r o n g nghien cUu Terzis [8] la 51 c m . NhUvay, doan
TK ghep phai ed dp dai bang 2/3 chieu dai eOa TK tru tU nguyen uy t d i eo tay nen ehi cd the sd d u n g dUdc mpt doan g h e p T K t r u .
Trong nhUng nghien cUu gan day, m p t sd tac gia chuyen re C7 ben lanh qua dUdng ham trudc edt song nhUm lam giam chieu dai doan ghep [10]. Tuy nhien, nhieu tae gia khac e ngai t i n h an toan cua ky t h u a t nay nen hien khdng ddgc ap d u n g rdng rai.
Theo Chuang [2], d u d n g ham nay rut n g i n d u d n g di cua doan g h e p ddgc khoang 10 em song co nhupc diem la hien tUdng dj cam xuat hien khi BN nudt do TK ghep n^m ngay phia sau thue quan.
Trong ky t h u a t cua chung tdi, cd m d t sd diem khac so vdi eac ky t h u a t dupe t r i n h bay t r o n g y van, d d la: Thd nhdt, doan ghep TK tru dUOc cap mau xudi
d o n g . Dau t r u n g t a m cua D M tru dUdc noi vdi dau t r u n g tam cua D M co ngang d ben t o n t h U d n g ; ngoai ra, cap mau cho phan t r u n g tam cua doan ghep TK tru edn dUdc t a n g eUdng bdi nhUng maeh mau nhd di vao bao ngoai eua TK d sat nguyen uy nen toan bd TK tru 6dOc cap mau hoan hcio, vi vay khdng xay ra t i n h trang hoai tU dan den xo hoa d trung tam [7], Thd hai, doan ghep TK tru dUdc gap ddi va Iu6n qua d u d n g ham dUdi xuong ddn ben ton t h u o n g va d u d n g ham phia trUdc khi quan de sang nen co ben lanh. Theo ehung t d i , day la dUdng di ngan nhat cua doan ghep, ket quci nghien cUu cho thay, chieu dai cua doan ghep cho TK cd bl va TK glUa lan I u d t l a 2 2 , 7 ± 1,5 cm va 24,1 ± 1,6 cm, ng^n hon khoang 10 cm neu sU d u n g TK ghep di qua d u d n g ham dudi da t h a n h ngUc trude nhU t r o n g nghien cUu eua Gu [4], day la yeu t d rat quan t r p n g lien quan tdi ket qua phuc hoi t r o n g ehuyen ghep than kinh. Thdba, re C7 cd 23.000 (17.000 - 40.000) Sdi TK trong khi TK tru ehi cd 14.161 (10.365 - 22.690) spi [1] nen neu sd d u n g m o t doan ghep TK tru nhU t r o n g ky thuat eua Gu [4] thi m o t lUdng Idn sdi true tU re C7 khdng di vao ddgc doan ghep. Do vay, viee sd d u n g TK tru gap ddi dam bao nhan tdi da so lupng soi TK cua C7 ben lanh lam n g u o n cho.
Ve tinh an toan cua ky thudt, vdi so lieu t r o n g nghien cUu nay va thUe tien ehuyen re C7 ben lanh qua dudng ham ndi tren d 171 BN (cd 61 BN dUdc ehuyen nUa re C7 ben lanh phuc hoi TK giUa khdng t r o n g nghien eUu nay), ehung tdi khdng gap trUdng h d p nao bi tal bien, bien chdng nghiem t r p n g nguy hiem den tinh mang nhU rach cac mach mau Idn, t u mau v u n g eo gay chen ep khi quan cung nhU nhiem khuan nang d vung mo. Trong nghien eUu cua ehung tdi, gap 2 trUdng hop het TK hoanh ben lanh tren BN da cd liet TK hoanh ben t o n t h u o n g do chan thUdng. Nguyen nhan la do TK hoanh bj keo cang t r o n g qua trinh phau tich de bdc Id cac re cua DRCT ben lanh. Tuy nhien, ca 2 BN nay deu phuc hoi va khdng de lai di chUng.
Ve tinh hieu qud cua ky thudt: D d n g tac gap khuyu la rat quan t r p n g cua chi tren, ddgc uu tien hang dau t r o n g phau t h u a t phuc hoi d chi het Cae
63
:*
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol1O-N°2/20.1S
tac gia deu t h o n g nhat phuc hoi gap khuj'u mi)c
> M3 daoc coi la CO y nghia [2]. Ket quS cua chung t o i 6 bdng 1 cho thay t i le phuc hoi gap khuyu mile >
M3 la 88,2% so BN. Trong do, t i le sulc gap khuyu dat mile M4 la 60,9%. Nghien cilu cua Chuang [2] d 23 BN phuc hoi d o n g t h d i TK co bi va TK gifla qua mpt doan ghep TK tru vdi thdi gian theo doi tren 4 nam cho thay: Phuc hoi gap khuyu miJc > M3 la 83% so BN. Nghien cuu cua Gao [3] d 22 BN cung vdi p h a o n g phap phau thuat n h u tren, vdi t h d i gian theo doi 4 nam, cho thay thl t l le phuc hoi gap khuyu mClc > M3 la 66,7% so BN. Nhu vay, ket qua cOa chung toi khdng khac biet khi so sanh vdi Chuang nhung cao hdn so vdi Gao. Trong thUc tien Viet Nam hien nay, hau het BN cua chung toi deu khdng dddc t a p van d p n g phuc hoi chdc nang chong teo ca mpt each cd he t h d n g n h d nghien cufu cCia tac gia nddc ngoai nen ket qua dat ddoc neu tren la khich le cho thdc hien tiep theo.
Ve ket qua phuc hoi cua TK gida, bao cao cua Waikakul [9] d 96 BN vdi ky thuat chuyen nCra re C7 cho TK gida cd thdi gian theo doi tren 3 nam cho thay tl le phuc hdi gap co tay va gap cac ngdn tay mdc > M3 lan Idpt la 29% va 2 1 % sd BN. Vdi ky thuat t d d n g t d , ket qua nghien cdu cua Songcharoen [6]
cho thay t l le phuc hoi gap co tay va cac ngdn tay la 29% so BN. Bao cao cua Chuang [2] d 23 BN ddpc phau thuat chuyen toan bp re C7 ben lanh chpTK ca bi va TK gida vdi t h d i gian theo ddi 4 nam thi ti le phuc hoi gap khu^u la 82,6% va gap co tay - cac n g d n tay mdc > M3 la 39% sd BN.
Trong nghien cdu cua chung t d i , bdng 2 vd bdng 3 cho thay t i le phuc hdi gap cp tay va gap cac ngdn tay dat mdc > M3 ian Idpt la 4 1 , 1 % va 27,7%i sd BN, ket qui^ nay khdng khac biet so vdi ket quB nghien cdu cua Waikakul, Songcharoen va Chuang neu tren.
Theo chung tdi, ket qu5 nay cung la khich ie trong hoan canh thdc tien Viet Nam.
Phuc hoi cam giac d mdc bao ve t r d len {> S2) khdng nhdng cd y nghia quan t r p n g giup BN tranh dddc cac t h d d n g tich doi vdi tay liet ma cdn tham gia vao qua trinh tai t o chdc vd nao khi ngUdi benh hoc m p t ky nang van d d n g mdi. Trong nghien cdu cua chung t d i , bdng 4 cho thay 100% sd BN sau
chuyen mo tren 36 t h a n g deu phuc hoi cSm gi Jc dg TK gida chi phdi d khu vdc ban tay dat mdc > SI;
t r o n g d o , 95,4% dat mdc a 52. Ket quS nay kh6r^' khac biet so vdi t;^ le 91,6% so BN dat mdc > S2 t r o n g nghien cdu cda Terzis [8], 83,3% dat mdc > S2 cda Waikakul [9] va 72,7% dat mdc > S2 trong nghien cdu cCia Gao [3],
5. Ket luan
- Chuyen re C7 ben lanh vdi doan ghep TK tru gap ddi qua d d d n g ham d d d i xddng ddn va trudc khi quSn la phau t h u a t an t o a n . Vdi than kinh tru gap d p i , van dSm bSo cap mau nudi hai dpan than kinh ghep de chdng hien t d d n g x d hda 6 trung tam doan ghep, chuyen dddc het cac sdi cua re C7 cho than kinh nhan ben liet.
- Ket qua chuyen re C7 qua 2 doan ghep rieng biet cho TK cd bi va TK gida dat van ddng gap k h u j u , gap co tay va cac n g d n tay mdc > M3 lan lilot la 88,2%, 29% va 2 1 % sd BN, phuc hdi cSm giac 6 ban tay mdc > S2 la 95,4% sd BN mac dij tap van d o n g phuc hoi chdc nang d u n g bai ban de chong t i n h trang tep c d cdn la thach thdc t r o n g dieu kien thdc te Viet Nam.
Tai lieu t h a m khSo
1 Bonnel F (1984) Microscopic anatomy of the adult human brachial plexus: An anatomical anil histological basis for microsurgery. Microsurg 5:
107-117.
2 Chuang D.C, Hernon C (2012) Minimum 4-yeat follow-up on contralateral C7 nerve transfers for brachial plexus injuries. J Hand Surg Am 37(2):
270-276.
3. Gao K., Lao J,'Zhao X. et ai (2013) Outcome ol contralateral C7 transfer to two recipient nen/es In22 patients with the total brachial plexus avulsion Injury. Microsurg.
1, Gu YD (1989) Neurotization by contralateral Cl.
Presented at the 9"" Symposium on the brachial plexus. Villars, Switzerland: 30-31.
J. Medical Research Council (1943) Aids to the Investigation of the peripheral nervous system
TAP CHl Y DU'O'C L A M S A N G 10 Tap 10-So 2/2015
London: Her Majesty's Stationary Office. Medical Research Council.
Songcharoen P, Wongtrakul S, Mahaisavariya B et al (2001) Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury. J Hand Surg Am 26(6): 1058-1064.
Taylor GI, Ham FJ (1975) The free vascularized nerve graft. Plast Reconstr Surg 56:166-170.
Terzis JK, Kostopoulos VK (2009) Vasculanzed ulnar nerve graft: 151 reconstructions for posttraumatic brachial plexus palsy. Plast Reconstr Surg 123(4):
1276-1291.
9. Waikakul S, Orapin S, Vanadurongwan V (1999) Clinieal results of contralateral C7 root neurotization to the median nerve In brachial plexus injuries with total root avulsions.) Hand Surg Br 24(5): 556-560.
10. Wang S, Yiu HW, Li P et al (2012) Contralateral C7 nerve root transfer to neurotize the upper trunk via a modified prespinal route In repair of brachial plexus avulsion injury. Microsurg 32(3): 183-188,
