Schreiber Joseph J, Byun David J, Khair Mahmoud M, Rosenblatt Lauren, Lee Steve K, Wolfe Scott W
New York, N.Y. From the Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery.
Plast Reconstr Surg. 2015 Jan;135(1):135e-141e. doi: 10.1097/PRS.0000000000000795.
Nerve transfer surgery has revolutionized the management of traumatic brachial plexus injures. However, the optimal size ratio of donor to recipient nerve has yet to be elucidated. The authors investigated the axon count ratios of ulnar and median fascicular transfers to restore elbow flexion. The authors hypothesized that donor nerve axon counts would be correlated with historical success of various nerve transfers used to restore elbow flexion.
Ten cadaveric specimens were used for a histomorphologic analysis of fascicular nerve transfers. Review of previously published axon counts and clinical results following transfer to the musculocutaneous nerve to restore elbow flexion was performed for the following donor nerves: medial pectoral, spinal accessory, intercostal, thoracodorsal, ulnar, and median fascicular.
The average number of fascicles identified was 7.9 in the ulnar nerve and 8.0 in the median nerve. The mean fascicular axon count was 1318 for the ulnar nerve and 1860 for the median nerve. Mean recipient nerve axon count was 1826 for the musculocutaneous biceps branch and 1840 for the brachialis branch. A significant correlation between axon count and clinical results of transfers to restore elbow flexion was observed. Donor-to-recipient nerve axon count ratios below 0.7:1 were associated with a decreased likelihood of a successful outcome.
In nerve transfers to restore elbow flexion, an appropriate size match between donor and recipient nerves appears to be a factor affecting clinical success. These data support a donor-to-recipient axon count ratio greater than 0.7:1 as the goal for brachial plexus nerve transfers to restore elbow flexion.
神经移植手术彻底改变了创伤性臂丛神经损伤的治疗方式。然而，供体神经与受体神经的最佳尺寸比例尚未明确。作者研究了尺神经和正中神经束状移植以恢复屈肘功能时的轴突计数比例。作者推测供体神经轴突计数与用于恢复屈肘功能的各种神经移植的既往成功率相关。
使用10个尸体标本进行束状神经移植的组织形态学分析。对以下供体神经进行回顾，这些神经在移植至肌皮神经以恢复屈肘功能后，已发表了轴突计数和临床结果：胸内侧神经、副神经、肋间神经、胸背神经、尺神经和正中神经束状。
尺神经中识别出的束平均数量为7.9，正中神经为8.0。尺神经的平均束状轴突计数为1318，正中神经为1860。肌皮神经肱二头肌支的平均受体神经轴突计数为1826，肱肌支为1840。观察到轴突计数与恢复屈肘功能的移植临床结果之间存在显著相关性。供体与受体神经轴突计数比例低于0.7:1与成功结果的可能性降低相关。
在恢复屈肘功能的神经移植中，供体神经与受体神经之间适当的尺寸匹配似乎是影响临床成功的一个因素。这些数据支持将供体与受体轴突计数比例大于0.7:1作为臂丛神经移植恢复屈肘功能的目标。
