Goubier Jean-Noel, Teboul Frédéric
International Center of Hand Surgery, Clinique du Parc Monceau, Paris, France.
Tech Hand Up Extrem Surg. 2007 Jun;11(2):139-41. doi: 10.1097/bth.0b013e31803105e1.
Restoration of elbow flexion is the first goal in brachial plexus injuries. The current procedures using nerve grafts and nerve transfers authorize more extensive repairs, with different possible targets: shoulder, elbow extension, and hand. Elbow extension is important to stabilize the elbow without the contralateral hand and allows achieving a useful grasp. The transfer of the intercostal nerves to the nerve of the long head of the triceps may restore this function in brachial plexus palsies. Furthermore, in case of C5 to C7 palsy, this transfer spares the radial nerve and gives a chance to spontaneous triceps recovery by the reinnervation from C8 root. Moreover, in case of absence or insufficient (M0 to M2 according to Medical Research Council scoring) recovery of elbow flexion strength by nerve surgery, the reinnervated triceps can be transferred. We present the technique of intercostal nerve transfer to the long head of the triceps branch to restore elbow extension in brachial plexus palsy. Results concerning 10 patients are presented.
恢复肘关节屈曲是臂丛神经损伤的首要目标。目前使用神经移植和神经移位的手术允许进行更广泛的修复，有不同的可能靶点：肩部、肘关节伸展和手部。肘关节伸展对于在没有对侧手的情况下稳定肘关节很重要，并且有助于实现有效的抓握。将肋间神经移位至肱三头肌长头神经可在臂丛神经麻痹中恢复此功能。此外，在C5至C7麻痹的情况下，这种移位可保留桡神经，并通过C8神经根的再支配使肱三头肌有自发恢复的机会。此外，如果通过神经手术肘关节屈曲力量没有恢复或恢复不足（根据医学研究委员会评分标准为M0至M2），则可移位已重新获得神经支配的肱三头肌。我们介绍了将肋间神经移位至肱三头肌长头分支以恢复臂丛神经麻痹时肘关节伸展的技术。本文展示了10例患者的结果。
