Robla-Costales J, Socolovsky M, Di Masi G, Robla-Costales D, Domitrovic L, Campero A, Fernández-Fernández J, Ibáñez-Plágaro J, García-Cosamalón J
Servicios de Neurocirugía, Hospital de León, León, España.
Neurocirugia (Astur). 2011 Dec;22(6):521-34.
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 a previous paper extraplexual nerve transfers were analyzed; this literature review complements the preceding paper analyzing intraplexual nerve transfers, and thus completing the analysis of the nerve transfers available in brachial plexus surgery.
在20世纪70年代和80年代，由于显微外科技术及其他进展，臂丛神经外科领域掀起了巨大的热潮。然而，在过去的二十年里，神经移位技术或称神经移植术的出现给臂丛神经外科带来了冲击。该技术是将一条供体神经切断，牺牲其原有功能，然后将其与一条受体神经的远侧残端相连，受体神经的功能在创伤中已丧失。当无法进行直接修复时，即当颈神经根在脊髓处从其起始部撕脱时，可采用神经移植术。近年来，由于其中一些神经移位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神经根的确切数量（未撕脱的）。若没有可用的神经根，则采用臂丛外神经移位，如副神经、膈神经、肋间神经等，以增加转移至受损臂丛神经的轴突数量。在所有神经根均撕脱的情况下，臂丛外神经移植是唯一可用于限制这种损伤长期破坏性影响的再支配选择。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在手术治疗手段中可用的适应证、结果及技术。由于通常在手术过程中才会选择手术技术，手术团队在手术前应完全掌握所有这些知识。在之前的一篇论文中分析了臂丛外神经移位；这篇文献综述对前文分析臂丛内神经移位进行了补充，从而完成了对臂丛神经外科中可用神经移位的分析。
