Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
Microsurgery. 2012 Feb;32(2):111-7. doi: 10.1002/micr.20962. Epub 2011 Oct 17.
The upper brachial plexus injury leads to paralysis of muscles innervated by C5 and C6 nerve roots. In this report, we present our experience on the use of the combined nerve transfers for reconstruction of the upper brachial plexus injury. Nine male patients with the upper brachial plexus injury were treated with combined nerve transfers. The time interval between injury and surgery ranged from 3 to 11 months (average, 7 months). The combined nerve transfers include fascicles of the ulnar nerve and/or the median nerve transfer to the biceps and/or the brachialis motor branch, and the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) and triceps branches to the axillary nerve through a posterior approach. At an average of 33 months of follow-up, all patients recovered the full range of the elbow flexion. Six out of nine patients were able to perform the normal range of shoulder abduction with the strength degraded to M3 or M4. These results showed that the technique of the combined nerve transfers, specifically the SAN to the SSN and triceps branches to the axillary nerve through a posterior approach, may be a valuable alternative in the repair of the upper brachial plexus injury. Further evaluations of this technique are necessary.
上臂丛神经损伤导致 C5 和 C6 神经根支配的肌肉瘫痪。在本报告中，我们介绍了使用联合神经转移术重建上臂丛神经损伤的经验。9 例男性上臂丛神经损伤患者接受联合神经转移术治疗。损伤与手术之间的时间间隔为 3 至 11 个月（平均 7 个月）。联合神经转移包括尺神经和/或正中神经束转移至肱二头肌和/或肱肌运动支，以及副神经（SAN）至肩胛上神经（SSN）和通过后路转移肱三头肌支至腋神经。平均随访 33 个月后，所有患者的屈肘均完全恢复。9 例中有 6 例能够进行正常的肩外展，力量降至 M3 或 M4。这些结果表明，联合神经转移术，特别是通过后路将 SAN 转移至 SSN 和将肱三头肌支转移至腋神经，可能是修复上臂丛神经损伤的一种有价值的替代方法。需要进一步评估该技术。
