腕神経叢引き抜き損傷に対し肋間神経—筋皮神経交差吻合術およびDREZ-tomyを施行した1症例

Intercostal Nerve Cross-Anastomosis and DREZ-tomy in a Patient with Brachial Plexus Avulsion: A case report

I．はじめに

　腕神経叢引き抜き損傷は，主にオートバイの転倒事故などにより惹起される外傷性疾患で，稀ならず経験するものである．今同われわれは令型腕神経叢損傷にもとつく患側肢の頑痛を発生した1症例を経験し，上肢機能再建に対しては肋間神経—筋皮神経交差吻合術を，そして頑痛に対しては脊髄後根進入部破壊術（DREZ-tomy）を施行し，共に良好な経過が得られたので文献的考察を加え報告する．

Abstract

An 18-year-old male with a right brachial plexus in-jury caused by a motorcycle accident was admitted on October 13, 1988. A detailed examination revealed that the brachial plexus was totally injured. The axon reflex test suggested that the lesion sites were postganglionic in the C₅ and C₆ nerves, and preganglionic in the C₇, C₈ and Th₁. On December 14, 1988, intercostal nerve cross-anastomosis was performed in the hope that a lost motor function of the right upper extremity could be restored as a first step. An electromyogram 6 months after this anastomotic operation demonstrated synkinesis between the biceps brachialis and the inter-costal muscles during deep inspiration. Fifteen months after this operation, active voluntary muscle discharges which were higher than before in amplitude, were pro-voked. The right elbow flexion was gradually restored independently of respiration. On the other hand, intrac-table pain with a persistent severe tingling sensation appeared approximately one week after the injury on the lesioned upper extremity. The pain rapidly in-creased in severity. The DREZ-tomy from C5 to Th, was performed on March 7, 1989. This has brought complete relief of the intractable pain. A brief discus-sion was given concerning some aspects of the brachial plexus avulsion and DREZ-tomy.