Mackinnon Susan E, Roque Brandon, Tung Thomas H
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Neurosurg. 2007 Sep;107(3):666-71. doi: 10.3171/JNS-07/09/0666.
The purpose of this study is to report a surgical technique of nerve transfer to restore radial nerve function after a complete palsy due to a proximal injury to the radial nerve. The authors report the case of a patient who underwent direct nerve transfer of redundant or expendable motor branches of the median nerve in the proximal forearm to the extensor carpi radialis brevis and the posterior interosseous branches of the radial nerve. Assessment included degree of recovery of wrist and finger extension, and median nerve function including pinch and grip strength. Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median nerve were noted, and the patient is very satisfied with her degree of functional restoration. Transfer of redundant synergistic motor branches of the median nerve can successfully reinnervate the finger and wrist extensor muscles to restore radial nerve function. This median to radial nerve transfer offers an alternative to nerve repair, graft, or tendon transfer for the treatment of radial nerve palsy.
本研究的目的是报告一种神经移植手术技术,用于在桡神经近端损伤导致完全麻痹后恢复桡神经功能。作者报告了一例患者,该患者接受了将前臂近端正中神经多余或可牺牲的运动分支直接移植到桡侧腕短伸肌和桡神经骨间后支的手术。评估包括腕部和手指伸展的恢复程度,以及正中神经功能,包括捏力和握力。术后6个月观察到神经再支配的临床证据。随访期为18个月。手指和腕部伸展功能几乎完全恢复,肌力为4/5级。术后捏力和握力有所改善。未发现与正中神经相关的运动或感觉功能障碍,患者对其功能恢复程度非常满意。正中神经多余协同运动分支的移植可成功地使手指和腕部伸肌重新获得神经支配,以恢复桡神经功能。这种正中神经至桡神经的移植为桡神经麻痹的治疗提供了一种替代神经修复、移植或肌腱移植的方法。