臂丛神经产瘫中肋间神经转位至肌皮神经的结果。
Results of intercostal nerve transfer to the musculocutaneous nerve in brachial plexus birth palsy.
作者信息
Luo Peng-Bo, Chen Liang, Zhou Cheng-Huan, Hu Shao-Nan, Gu Yu-Dong
机构信息
Department of Hand Surgery, Huashan Hospital, Fu-dan University, Shanghai, China.
出版信息
J Pediatr Orthop. 2011 Dec;31(8):884-8. doi: 10.1097/BPO.0b013e318230a783.
BACKGROUND
Intercostal nerve (ICN) transfer has been one of the main extraplexal nerve transfers in treating brachial plexus root avulsion. This retrospective study evaluated results of ICN transfer for reconstruction of the musculocutaneous nerve (MCN) in brachial plexus birth palsy (BPBP).
METHODS
Eighteen boys and 6 girls with BPBP, who had avulsion of at least 2 spinal nerves of the plexus, underwent ICN transfer for reconstruction of MCN, from March 2003 to October 2005. The brachial plexus lesion was diagnosed by clinical assessment, surgical exploration, and intraoperative neurophysiological investigations. The age at surgery ranged from 3 to 11 months of life, with a mean of 5 months. Two intercostals were used for one, 3 intercostals for 9, and 4 intercostals for 14 patients. The intercostals were transferred to MCN in 12 and to the anterior division of the upper trunk in the other 12 cases.
RESULTS
Twenty-four children were followed up for 24 to 79 months, with an average of 53 months. No complications were found in the respiratory system. Of 14 transfers with 4 intercostals, biceps gained M4 strength in 8, M3 in 4, and M2 in 2. Of 9 transfers with 3 intercostals, biceps obtained M4 strength in 8 and M3 in 1. One transfer with 2 intercostals got M4 strength of biceps. Twelve patients whose intercostals were transferred to MCN, gained M4 strength of biceps in 11 and M3 in 1, whereas the other 12 patients with intercostals transferred to anterior division of the upper trunk, obtained M4 strength of biceps in 6, M3 in 4, and M2 in 2. The rate of M3 strength or more was 92% and that of M4 was 71%.
CONCLUSIONS
ICN transfer is a safe and reliable procedure for reconstruction of the MCN in BPBP. There seems to be no difference of effects between transfers with 3 and those with 4 intercostals. The transferred nerves should be coapted to MCN, rather than a more proximal portion of the plexus.
LEVEL OF EVIDENCE
Level III: retrospective comparative study.
背景
肋间神经（ICN）移位术一直是治疗臂丛神经根性撕脱伤的主要非丛内神经移位术之一。本回顾性研究评估了肋间神经移位术在治疗臂丛神经产瘫（BPBP）中重建肌皮神经（MCN）的效果。
方法
2003年3月至2005年10月，对18例男孩和6例女孩的臂丛神经产瘫患者进行了肋间神经移位术重建肌皮神经，这些患者的臂丛神经至少有2条脊神经发生撕脱。通过临床评估、手术探查和术中神经电生理检查诊断臂丛神经损伤。手术年龄为3至11个月，平均5个月。1例患者使用2根肋间神经，9例使用3根肋间神经，14例使用4根肋间神经。12例患者的肋间神经移位至肌皮神经，另外12例患者的肋间神经移位至上干前股。
结果
24例患儿随访24至79个月，平均53个月。呼吸系统未发现并发症。在14例使用4根肋间神经移位的患者中，肱二头肌肌力达到M4的有8例，M3的有4例，M2的有2例。在9例使用3根肋间神经移位的患者中，肱二头肌肌力达到M4的有8例，M3的有1例。1例使用2根肋间神经移位的患者肱二头肌肌力达到M4。12例肋间神经移位至肌皮神经的患者中，肱二头肌肌力达到M4的有11例，M3的有1例；而另外12例肋间神经移位至上干前股的患者中，肱二头肌肌力达到M4的有6例，M3的有4例，M2的有2例。M3及以上肌力的比例为92%，M4肌力的比例为71%。
结论
肋间神经移位术是重建臂丛神经产瘫中肌皮神经的一种安全可靠的手术方法。使用3根肋间神经移位和4根肋间神经移位的效果似乎没有差异。移位神经应与肌皮神经吻合，而不是与臂丛神经更近端的部分吻合。
证据级别
III级：回顾性比较研究。
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