Moiyadi Aliasgar Vajihuddin, Devi Bhagavatula Indira, Nair K P Sivaraman
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
J Neurosurg. 2007 Aug;107(2):308-13. doi: 10.3171/JNS-07/08/0308.
Brachial plexus root avulsion injuries, which are devastating, usually result from high-speed accidents. Nerve transfer provides hope for successful treatment of this difficult set of injuries. Nevertheless, the controversies regarding indications, techniques, and outcome of the various available surgical procedures continue.
A retrospective analysis was performed in 51 patients (43 male and eight female patients) with brachial plexus injuries who underwent neurotization at the authors' institute between 1997 and 2003. Clinical, electrophysiological, and imaging data were used to identify the type and pattern of involvement of the various elements of the plexus. The mean duration of denervation was 6.4 months (range 2-24 months). Outcome was computed in terms of the overall improvement in power of the target muscle as well as the functional usefulness of such recovery.
There were 50 supraclavicular injuries (25 preganglionic, eight postganglionic, and 17 mixed). One patient had an infraclavicular (posterior spinal cord) injury. Pan-brachial plexus injury with a flail upper limb was the most common pattern. Overall, 55 nerves were neurotized-33 musculocutaneous, 18 axillary, and two each for ulnar and radial nerves (47 single and four double neurotizations-by using intercostal nerve donors in the majority of cases. Adequate follow-up data were available in 36 patients (38 nerves) and these were used for the analysis of outcome. Overall, 58.3% of patients had improvement, and of these 62% achieved useful recovery. This accounted for 36% of overall useful recovery. Multiple logistic regression analysis revealed that regardless of age, sex, mode and pattern of injury, and recipient nerve, the duration of denervation showed a trend toward significance that correlated with overall (but not useful) improvement. The critical duration of denervation was 5.5 months.
Neurotization for brachial plexus root avulsion injuries is a viable option. Early detection and intervention (within 5.5 months) leads to a better overall recovery.
臂丛神经根撕脱伤后果严重，通常由高速事故导致。神经移位术为成功治疗这类棘手损伤带来了希望。然而，关于各种现有外科手术的适应症、技术及结果仍存在争议。
对1997年至2003年间在作者所在机构接受神经移位术的51例臂丛神经损伤患者（43例男性，8例女性）进行回顾性分析。利用临床、电生理及影像学数据确定臂丛各组成部分的损伤类型和模式。失神经支配的平均持续时间为6.4个月（范围2 - 24个月）。根据目标肌肉力量的总体改善情况以及这种恢复的功能实用性来计算结果。
有50例为锁骨上损伤（25例节前损伤、8例节后损伤和17例混合损伤）。1例患者为锁骨下（脊髓后束）损伤。全臂丛神经损伤伴连枷上肢是最常见的模式。总体而言，55条神经进行了神经移位——33条肌皮神经、18条腋神经、尺神经和桡神经各2条（47例单次神经移位和4例双重神经移位——大多数情况下使用肋间神经作为供体神经）。36例患者（38条神经）有充分的随访数据，用于结果分析。总体而言，58.3%的患者有改善，其中62%实现了有效恢复。这占总体有效恢复的36%。多因素逻辑回归分析显示，无论年龄、性别、损伤方式和模式以及受区神经如何，失神经支配的持续时间显示出与总体（但非有效）改善相关的显著趋势。失神经支配的关键持续时间为5.5个月。
臂丛神经根撕脱伤的神经移位术是一种可行的选择。早期发现并干预（在5.5个月内）可带来更好的总体恢复。
