Center of Biological and Health Sciences, Department of Neurosurgery, University of the Southern of Santa Catarina (Unisul), Tubarão, SC, Brazil.
Neurosurgery. 2012 Aug;71(2):259-62; discussion 262-3. doi: 10.1227/NEU.0b013e3182571971.
In complete brachial plexus palsy, we have hypothesized that grafting to the musculocutaneous nerve should restore some hand sensation because the musculocutaneous nerve can drive hand sensation directly or via communication with the radial and median nerves.
To investigate sensory recovery in the hand and forearm after C5 root grafting to the musculocutaneous nerve in patients with a total brachial plexus injury.
Eleven patients who had recovered elbow flexion after musculocutaneous nerve grafting from a preserved C5 root and who had been followed for a minimum of 3 years were screened for sensory recovery in the hand and forearm. Six matched patients who had not undergone surgery served as controls. Methods of assessment included testing for pain sensation using Adson forceps, cutaneous pressure threshold measurements using Semmes-Weinstein monofilaments, and the static 2-point discrimination test. Deep sensation was evaluated by squeezing the first web space, and thermal sensation was assessed using warm and cold water.
All grafted patients recovered sensation in a variable territory extending from just over the thenar eminence to the entire lateral forearm and hand. Seven patients were capable of perceiving 2-0 monofilament pressure on the thenar eminence, palm, and dorsoradial aspect of the hand. All could differentiate warm and cold water. None recovered 2-point discrimination. None of the patients in the control group recovered any kind of sensation in the affected limb.
Grafting the musculocutaneous nerve can restore nociceptive sensation on the radial side of the hand.
在全臂丛神经损伤中，我们假设将神经移植物接至肌皮神经，应该可以恢复部分手部感觉，因为肌皮神经可以直接或通过与桡神经和正中神经的通讯来驱动手部感觉。
研究 C5 神经根移植至肌皮神经后全臂丛神经损伤患者手部和前臂的感觉恢复情况。
筛选出 11 例因保留的 C5 神经根肌皮神经移植而恢复肘部屈曲且随访至少 3 年的患者，以评估手部和前臂的感觉恢复情况。6 例匹配的未手术患者作为对照。评估方法包括使用 Adson 夹测试痛觉、使用 Semmes-Weinstein 单丝测试皮肤压力阈值，以及静态 2 点辨别测试。通过挤压第一蹼间区评估深部感觉，通过温水和冷水评估温度感觉。
所有接受移植的患者在手和整个前臂的外侧，从大鱼际上方延伸到特定区域都恢复了感觉。7 例患者能够感知到在大鱼际、手掌和手的背侧桡侧有 2-0 单丝压力。所有患者都能区分冷热水。但没有患者恢复两点辨别。对照组的所有患者在患侧肢体都没有恢复任何感觉。
肌皮神经移植可以恢复手部桡侧的痛觉。
