Department of Hand Surgery, Beijing Jishuitan Hospital, No. 31 East Street of Xinjiekou, West District, Beijing 100035, Republic of China.
J Bone Joint Surg Am. 2013 May 1;95(9):821-7, S1-2. doi: 10.2106/JBJS.L.00039.
Contralateral C7 nerve transfer to the median nerve has been used in an attempt to restore finger flexion in patients with total brachial plexus avulsion injury. However, the results have not been satisfactory mainly because of the requirement to use a long bridging nerve graft, which causes an extended nerve regeneration process and irreversible muscle atrophy. A new procedure involving contralateral C7 nerve transfer via a modified prespinal route and direct coaptation with the injured lower trunk is presented here.
Contralateral C7 nerve transfer via the modified prespinal route and direct coaptation with the injured lower trunk was performed in seventy-five patients with total brachial plexus avulsion injury. Thirty-five required humeral shortening osteotomy (3 to 4.5 cm) in order to accomplish the direct coaptation. The contralateral C7 nerve was also transferred to the musculocutaneous nerve through the bridging medial antebrachial cutaneous nerve arising from the lower trunk in forty-seven of the seventy-five patients. Recovery of finger, wrist, and elbow flexion was evaluated with use of the modified British Medical Research Council muscle grading system.
The mean follow-up period (and standard deviation) was 57 ± 6 months (range, forty-eight to seventy-eight months). Motor function with a grade of M3+ or greater was attained in 60% of the patients for elbow flexion, 64% of the patients for finger flexion, 53% of the patients for thumb flexion, and 72% of the patients for wrist flexion.
Contralateral C7 nerve transfer via a modified prespinal route and direct coaptation with the injured lower trunk decreases the distance for nerve regeneration in patients with total brachial plexus avulsion injury. There was satisfactory recovery of finger flexion and wrist flexion in this series. In addition, contralateral C7 nerve transfer was successfully used to repair two different target nerves: the lower trunk and the musculocutaneous nerve.
为了恢复全臂丛神经撕脱伤患者的手指屈曲功能，已经尝试进行对侧 C7 神经移位至正中神经。然而，结果并不令人满意，主要是因为需要使用长的桥接神经移植物，这导致了延长的神经再生过程和不可逆转的肌肉萎缩。本文介绍了一种新的手术方法，即通过改良的脊前途径进行对侧 C7 神经移位，并直接与损伤的下干吻合。
对 75 例全臂丛神经撕脱伤患者进行了改良脊前途径对侧 C7 神经移位并直接与损伤的下干吻合。为了实现直接吻合，35 例患者需要肱骨缩短截骨术（3 至 4.5 厘米）。在这 75 例患者中的 47 例中，将对侧 C7 神经通过发自下干的桥接正中神经皮支转移至肌皮神经。采用改良的英国医学研究理事会肌肉分级系统评估手指、腕和肘屈曲的恢复情况。
平均随访时间（标准差）为 57±6 个月（范围，48 至 78 个月）。60%的患者肘部屈曲运动功能达到 M3+或以上，64%的患者手指屈曲运动功能达到 M3+或以上，53%的患者拇指屈曲运动功能达到 M3+或以上，72%的患者腕部屈曲运动功能达到 M3+或以上。
通过改良的脊前途径进行对侧 C7 神经移位并直接与损伤的下干吻合，可缩短全臂丛神经撕脱伤患者的神经再生距离。本系列患者的手指屈曲和腕部屈曲恢复情况令人满意。此外，对侧 C7 神经移位成功用于修复两个不同的靶神经：下干和肌皮神经。
