Bertelli Jayme Augusto, Ghizoni Marcos Flávio
Governador Celso Ramos Hospital, Florianópolis, SC, Brazil.
J Hand Surg Am. 2009 Dec;34(10):1821-6. doi: 10.1016/j.jhsa.2009.08.004.
Vascularized nerve grafts are indicated for the repair of large nerve defects. In brachial plexus injuries, the poor prognosis for functional hand reconstruction when the lower roots are avulsed makes the ulnar nerve a potential donor for vascularized nerve grafts. We report on the results we obtained with reconstruction of elbow flexion using long pedicled ulnar nerve grafts that connected the C5 root to the musculocutaneous nerve.
We prospectively studied 8 young adults with complete brachial plexus palsy with avulsion of the lower roots, who had surgical repair an average of 4.6 months after trauma. Pedicled ulnar nerve grafts, averaging 30 cm long, connected the C5 root to the musculocutaneous nerve. In order to rescue misdirected axons that could have regenerated into the cutaneous branch of the musculocutaneous nerve, we transferred this branch to the motor branch of the extensor carpi radialis brevis muscle. Outcomes for all 8 patients were assessed an average of 26.7 months after surgery, focusing on recovery of muscle strength, categorized using the Medical Research Council scale.
None of the patients recovered elbow flexion or wrist extension greater than M2.
In brachial plexus injuries, reconstruction of elbow flexion using a long, pedicled, vascularized nerve graft produces unsatisfactory results.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
血管化神经移植适用于修复大的神经缺损。在臂丛神经损伤中，当下部神经根撕脱时，手部功能重建预后较差，这使得尺神经成为血管化神经移植的潜在供体。我们报告了使用长蒂尺神经移植将C5神经根与肌皮神经相连来重建肘关节屈曲功能的结果。
我们前瞻性研究了8例患有完全性臂丛神经麻痹且下部神经根撕脱的年轻成年人，他们在创伤后平均4.6个月接受了手术修复。平均长度为30厘米的带蒂尺神经移植将C5神经根与肌皮神经相连。为了挽救可能已长入肌皮神经皮支的迷走轴突，我们将该皮支转移至桡侧腕短伸肌的运动支。对所有8例患者在术后平均26.7个月时进行评估，重点关注肌肉力量的恢复情况，采用医学研究理事会量表进行分类。
所有患者的肘关节屈曲或腕关节伸展恢复均未超过M2。
在臂丛神经损伤中，使用长的、带蒂的、血管化神经移植重建肘关节屈曲功能的效果并不理想。
研究类型/证据水平：治疗性IV级。
