Zhu L, Yang D, Chen A
Changzheng Hospital, The Second Military Medical University, 415 Fengyang Rd, Huangpu District, Shanghai, China.
Bone Joint J. 2015 Mar;97-B(3):358-65. doi: 10.1302/0301-620X.97B3.34330.
The aim of this study was to evaluate the feasibility of using the intact S1 nerve root as a donor nerve to repair an avulsion of the contralateral lumbosacral plexus. Two cohorts of patients were recruited. In cohort 1, the L4-S4 nerve roots of 15 patients with a unilateral fracture of the sacrum and sacral nerve injury were stimulated during surgery to establish the precise functional distribution of the S1 nerve root and its proportional contribution to individual muscles. In cohort 2, the contralateral uninjured S1 nerve root of six patients with a unilateral lumbosacral plexus avulsion was transected extradurally and used with a 25 cm segment of the common peroneal nerve from the injured leg to reconstruct the avulsed plexus. The results from cohort 1 showed that the innervation of S1 in each muscle can be compensated for by L4, L5, S2 and S3. Numbness in the toes and a reduction in strength were found after surgery in cohort 2, but these symptoms gradually disappeared and strength recovered. The results of electrophysiological studies of the donor limb were generally normal. Severing the S1 nerve root does not appear to damage the healthy limb as far as clinical assessment and electrophysiological testing can determine. Consequently, the S1 nerve can be considered to be a suitable donor nerve for reconstruction of an avulsed contralateral lumbosacral plexus.
本研究的目的是评估使用完整的S1神经根作为供体神经修复对侧腰骶丛撕脱伤的可行性。招募了两组患者。在队列1中，在手术过程中对15例单侧骶骨骨折和骶神经损伤患者的L4-S4神经根进行刺激，以确定S1神经根的精确功能分布及其对各肌肉的比例贡献。在队列2中，将6例单侧腰骶丛撕脱伤患者的对侧未受伤的S1神经根在硬膜外横断，并与来自受伤侧小腿的25 cm腓总神经段一起用于重建撕脱的神经丛。队列1的结果表明，L4、L5、S2和S3可代偿各肌肉中S1的神经支配。队列2的患者术后出现脚趾麻木和力量减弱，但这些症状逐渐消失且力量恢复。供体肢体的电生理研究结果总体正常。就临床评估和电生理测试所能确定的而言，切断S1神经根似乎不会损害健康肢体。因此，S1神经可被认为是重建对侧腰骶丛撕脱伤的合适供体神经。
