Robla-Costales J, Socolovsky M, Di Masi G, Domitrovic A Campero J Fernández-Fernández J Ibáñez-Plágaro J García-Cosamalón L, Campero A, Fernández-Fernández J, Ibáñez-Plágaro J, García-Cosamalón J
Servicio de Neurocirugía. Hospital de León, León, España.
Neurocirugia (Astur). 2011 Dec;22(6):507-20.
After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact number of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order to clarify the concerned readers the indications, results and techniques available in the surgical armamentarium for this condition. Since the choice of either surgical technique is usually taken during the course of the procedure, all this knowledge should be perfectly embodied by the surgical team before the procedure. In this first part extraplexual nerve transfers are analyzed, while intraplexual nerve transfers will be analyzed in the second part of this presentation.
在20世纪70年代和80年代，由于显微外科技术及其他进展融入臂丛神经手术，该领域曾掀起巨大热潮。然而在过去二十年中，神经移植技术或神经移位术的出现给臂丛神经手术带来了冲击。这种技术是将一条供体神经切断，牺牲其原有功能，然后将其与受体神经的远端残端相连，该受体神经的功能在创伤中丧失。当无法进行直接修复时，即颈神经根在脊髓起始处发生撕脱时，可采用神经移位术。近年来，由于其中一些神经移植技术取得了积极成果，它们甚至在一些臂丛神经根得以保留的病例中也得到了广泛应用。在完全性臂丛神经损伤中，必须确定可用于直接重建的可用神经根的确切数量（未撕脱）。如果没有可用的神经根，则采用臂丛外神经移植，如副神经、膈神经、肋间神经等，以增加转移至受损臂丛的轴突数量。在所有神经根均发生撕脱的情况下，臂丛外神经移位术是唯一可用的再支配选择，以减轻这种损伤的长期严重影响。鉴于近年来已发表了大量关于臂丛神经创伤性损伤的报告，撰写本文是为了向相关读者阐明针对这种情况的手术方法中的适应证、结果及技术。由于通常在手术过程中才会选择手术技术，所以手术团队在手术前应完全掌握所有这些知识。在第一部分中，将分析臂丛外神经移位术，而臂丛内神经移位术将在本报告的第二部分中进行分析。
