Yang Paul R, Brunworth Louis S, Gray Robert R, Cardoso Roy
Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, Florida.
J Reconstr Microsurg. 2014 Jun;30(5):343-8. doi: 10.1055/s-0033-1363774. Epub 2014 Feb 17.
Traumatic brachial plexus injuries are life changing, often leaving affected individuals with severe functional deficits. Recent advances in nerve transfers have allowed surgeons to improve elbow flexion, shoulder abduction, and prehension of the hand in some patients. We hypothesize that in a patient who lacks both biceps and triceps function, a double fascicular transfer may be the key to restore elbow flexion and extension. In three cadaver upper limbs, we transferred the expendable motor fascicle of the ulnar nerve to the biceps branch of the musculocutaneous nerve, and the expendable motor fascicle of the median nerve to the triceps (ulnar collateral) branch of the radial nerve. We evaluated the feasibility of this double nerve transfer via a medial approach, and elucidated the anatomy. The transfers were easily performed and were tension-free throughout full range of motion at the elbow. The triceps branch of the radial nerve that we utilized has a length of approximately 4.9 cm, and is best found between 3.5 and 6 cm from the anterior axillary line. We consistently identified a relatively avascular plane in the region between 7.5 and 11 cm from the anterior axillary line, which corresponds with the recipient sites of the medial head of the triceps. The distance between the triceps branch to the median nerve was an average of 2.5 cm. Transfer of expendable motor fascicles from the ulnar and median nerves to the biceps and triceps nerve branches can be successfully and consistently performed through a medial approach in a cadaver.
创伤性臂丛神经损伤会改变人生，常使患者出现严重的功能缺陷。神经移位术的最新进展使外科医生能够在一些患者中改善肘部屈曲、肩部外展和手部抓握功能。我们推测，对于同时缺乏肱二头肌和肱三头肌功能的患者，双束神经移位术可能是恢复肘部屈伸功能的关键。在三具尸体上肢中，我们将尺神经的可牺牲运动束转移至肌皮神经的肱二头肌分支，将正中神经的可牺牲运动束转移至桡神经的肱三头肌（尺侧副）分支。我们通过内侧入路评估了这种双神经移位术的可行性，并阐明了其解剖结构。移位术操作简便，在肘部全范围活动过程中均无张力。我们所利用的桡神经肱三头肌分支长度约为4.9厘米，最佳位置在前腋前线3.5至6厘米之间。我们始终在前腋前线7.5至11厘米区域内发现一个相对无血管的平面，该平面与肱三头肌内侧头的受区相对应。肱三头肌分支与正中神经之间的距离平均为2.5厘米。在尸体上通过内侧入路可成功且稳定地将尺神经和正中神经的可牺牲运动束转移至肱二头肌和肱三头肌神经分支。
