Bertelli Jayme Augusto, Ghizoni Marcos Flávio
Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil.
J Hand Surg Am. 2010 May;35(5):769-75. doi: 10.1016/j.jhsa.2010.01.004. Epub 2010 Mar 25.
To investigate the results of distal nerve transfer, with and without nerve root grafting, in C5-C6 palsy of the brachial plexus.
We prospectively studied 37 young adults with C5-C6 brachial plexus palsy who underwent surgical repair an average of 6.3 months after trauma. In 7 patients, no nerve roots were available for grafting, so reconstruction was achieved by transferring the accessory nerve to the suprascapular nerve, ulnar nerve fascicles to the biceps motor branch, and triceps branches to the axillary nerve (a triple nerve transfer). In 24 patients, C5 nerve root grafting to the anterior division of the upper trunk was combined with triple nerve transfer. In 6 patients, the C5+C6 nerve roots were grafted to the anterior and posterior divisions of the upper trunk, the accessory nerve was transferred to the suprascapular nerve, and ulnar nerve fascicles were connected to the biceps motor branch. The range of shoulder abduction/external rotation recovery and elbow flexion strength were evaluated between 24 and 26 months after surgery.
Both full abduction and full external rotation of the shoulder were restored in one of the 7 patients in the C5 and C6 nerve root avulsion group, in 14 of 21 patients who received C5 nerve root grafting, and in 2 of 6 patients in the C5+C6 nerve root graft group. The average percentages of elbow flexion strength recovery, relative to the normal, contralateral side, were 27%, 43%, and 59% for the C5-C6 nerve root avulsion, C5 nerve root graft, and C5+C6 nerve root graft groups, respectively.
We repaired C5-C6 brachial plexus palsies using a combination of strategies depending on the site of root injury (ie, intradural vs extradural). Patients with injuries that were able to be reconstructed with both root grafting and nerve transfers had the best function. These results suggest that the combined use of nerve transfers and root grafting may enhance outcomes in the reconstruction of C5-C6 injuries of the brachial plexus.
探讨在臂丛神经C5 - C6麻痹中，进行和不进行神经根移植的远侧神经移位术的效果。
我们前瞻性研究了37例患有C5 - C6臂丛神经麻痹的年轻成年人，他们在创伤后平均6.3个月接受了手术修复。7例患者没有可用的神经根进行移植，因此通过将副神经移位至肩胛上神经、尺神经束移位至肱二头肌运动支以及肱三头肌分支移位至腋神经（三联神经移位）来实现重建。24例患者将C5神经根移植至上干前股并联合三联神经移位。6例患者将C5 + C6神经根移植至上干的前股和后股，副神经移位至肩胛上神经，尺神经束连接至肱二头肌运动支。在术后24至26个月评估肩外展/外旋恢复范围和肘屈曲力量。
在C5和C6神经根撕脱组的7例患者中，有1例恢复了肩部的全外展和全外旋；在接受C5神经根移植的21例患者中，有14例恢复；在C5 + C6神经根移植组的6例患者中，有2例恢复。相对于正常对侧，C5 - C6神经根撕脱组、C5神经根移植组和C5 + C6神经根移植组的肘屈曲力量恢复的平均百分比分别为27%、43%和59%。
我们根据神经根损伤部位（即硬膜内与硬膜外）采用多种策略组合修复C5 - C6臂丛神经麻痹。能够通过神经根移植和神经移位重建损伤的患者功能最佳。这些结果表明，联合使用神经移位和神经根移植可能会改善臂丛神经C5 - C6损伤的重建效果。
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