Bertelli Jayme Augusto, Ghizoni Marcos Flavio
Hospital Governador Celso Ramos, Praça Getulio Vargas 322, Florianópolis, Santa Catarina 88020030, Brazil.
Neurosurgery. 2003 Jun;52(6):1385-9; discussion 1389-90. doi: 10.1227/01.neu.0000065134.21334.d7.
Complete avulsion of the brachial plexus is a devastating injury that primarily affects young adults. The current treatment is based on nerve transfers, which yield very limited recovery. In this study, brachial plexus injuries were repaired with nerve transfers and nerve grafts directly implanted into the spinal cord.
Eight patients with complete brachial plexus avulsion injuries were surgically treated. Roots or target nerves of the brachial plexus were repaired with peripheral nerve grafts directly implanted into the spinal cord and with extraplexal nerve transfers.
Muscle reinnervation was observed for six patients who received spinal implants. Among those patients, one recovered M4 muscle power. Reinnervation was observed only in proximal upper limb muscles.
Muscle reinnervation through nerve grafts directly implanted into the spinal cord was demonstrated. It seems that the combination of intra- and extradural neurotizations improves the proximal muscle function results. However, the extent of this improvement is limited and, in our opinion, does not justify the use of spinal implants.
臂丛神经完全撕脱伤是一种主要影响年轻人的严重损伤。目前的治疗方法基于神经移位术，但其恢复非常有限。在本研究中，臂丛神经损伤通过神经移位术和直接植入脊髓的神经移植进行修复。
对8例臂丛神经完全撕脱伤患者进行手术治疗。臂丛神经的根部或靶神经通过直接植入脊髓的周围神经移植和臂丛外神经移位进行修复。
6例接受脊髓植入的患者观察到肌肉再支配。在这些患者中，1例恢复到M4肌力。仅在上肢近端肌肉观察到再支配。
证实了通过直接植入脊髓的神经移植实现肌肉再支配。似乎硬膜内和硬膜外神经化的联合应用改善了近端肌肉功能结果。然而，这种改善程度有限，并且在我们看来，使用脊髓植入物并不合理。
