Terzis Julia K, Kostopoulos Vasileios K
Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Microsurgical Program, Eastern Virginia Medical School.
Plast Reconstr Surg. 2009 Apr;123(4):1276-1291. doi: 10.1097/PRS.0b013e31819f2afd.
Vascularized nerve grafts were introduced in 1976. Subsequent studies have suggested the superiority of vascularized nerve grafts. In this study, the authors present 23 years' experience with vascularized ulnar nerve graft. The factors influencing outcomes and a comparison with conventional nerve grafts are presented.
Between 1981 and 2003, 151 reconstructions with ulnar nerve were performed in 67 patients for brachial plexus injuries. Patients were divided into four groups: those with vascularized ulnar nerve graft from ipsilateral donors, pedicled or free, and those with vascularized ulnar nerve graft from contralateral donors to median nerve or to single motor targets (e.g., axillary, musculocutaneous, triceps) (n = 25, 21, 13, and 8, respectively).
Patients with long denervation times yielded inferior results compared with those operated on early. Pedicle and free ipsilateral ulnar nerve grafts yielded comparable results for biceps muscle neurotization. Neurotization of biceps with a vascularized ulnar nerve graft from the contralateral root was not as effective as neurotization from ipsilateral donors. There was a difference in muscle grading when the target was the median nerve versus single motor targets such as axillary, musculocutaneous, or triceps, but there were no differences between preoperative and postoperative muscle grading of median innervated muscles.
Vascularized ulnar nerve grafting is the appropriate solution for brachial plexus injuries with C8 and T1 root avulsion, with outcomes that are superior to those achieved with conventional nerve grafts. Although few changes have been made over time, the use of ulnar nerve grafts for neurotization of multiple motor targets of the median nerve from contralateral donors is under consideration.
带血管神经移植术于1976年被引入。随后的研究表明带血管神经移植术具有优越性。在本研究中，作者介绍了23年带血管尺神经移植的经验。文中阐述了影响手术效果的因素，并与传统神经移植术进行了比较。
1981年至2003年间，67例患者因臂丛神经损伤接受了151次尺神经重建手术。患者被分为四组：分别采用同侧带血管蒂或游离尺神经移植、采用对侧带血管尺神经移植至正中神经或单一运动靶点（如腋神经、肌皮神经、肱三头肌）（每组分别为25例、21例、13例和8例）。
与早期手术的患者相比，去神经时间长的患者手术效果较差。带血管蒂和游离同侧尺神经移植在肱二头肌神经化方面效果相当。用对侧带血管尺神经移植至肱二头肌的神经化效果不如同侧供体。当靶点为正中神经与腋神经、肌皮神经或肱三头肌等单一运动靶点时，肌肉分级存在差异，但正中神经支配的肌肉术前和术后的肌肉分级无差异。
带血管尺神经移植术是治疗C8和T1神经根撕脱性臂丛神经损伤的合适方法，其效果优于传统神经移植术。尽管随着时间推移变化不大，但仍在考虑使用对侧供体的尺神经移植至正中神经的多个运动靶点进行神经化。
