Yang Guang, Chang Kate W-C, Chung Kevin C
Changchun, Jilin, People's Republic of China; and Ann Arbor, Mich. From the Department of Hand Surgery, China-Japan Union Hospital of Jilin University; and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
Plast Reconstr Surg. 2015 Oct;136(4):794-809. doi: 10.1097/PRS.0000000000001494.
Contralateral C7 (CC7) transfer has been used for treating traumatic brachial plexus injury. However, the effectiveness of the procedure remains a subject of debate. The authors performed a systematic review to study the overall outcomes of CC7 transfer to different recipient nerves in traumatic brachial plexus injuries.
A literature search was conducted using PubMed and EMBASE databases to identify original articles related to CC7 transfer for traumatic brachial plexus injury. The data extracted were study/patient characteristics, and objective outcomes of CC7 transfer to the recipient nerves. The authors normalized outcome measures into a Medical Research Council-based (MRC) outcome scale.
Thirty-nine studies were identified. The outcomes were categorized based on the major recipient nerves: median, musculocutaneous, and radial/triceps. Regarding overall functional recovery, 11 percent of patients achieved MRC grade M4 wrist flexion and 38 percent achieved MRC grade M3. Grade M4 finger flexion was achieved by 7 percent of patients, whereas 36 percent achieved M3. Finally, 56 percent achieved greater than or equal to S3 sensory recovery in the median nerve territories. In the musculocutaneous nerve group, 38 percent regained to M4 and 37 percent regained to M3. In the radial/triceps nerve group, 25 percent regained elbow or wrist extension strength to a MRC grade M4 and to M3, respectively.
Outcome measures in the included studies were not consistently reported to uncover true patient-related benefits from the CC7 transfer. Reliable and validated outcome instruments should be applied to critically evaluate patients undergoing CC7 transfer.
对侧C7（CC7）移位术已用于治疗创伤性臂丛神经损伤。然而，该手术的有效性仍是一个有争议的话题。作者进行了一项系统评价，以研究CC7移位至创伤性臂丛神经损伤中不同受区神经后的总体疗效。
使用PubMed和EMBASE数据库进行文献检索，以识别与CC7移位治疗创伤性臂丛神经损伤相关的原始文章。提取的数据包括研究/患者特征，以及CC7移位至受区神经后的客观疗效。作者将疗效指标标准化为基于医学研究委员会（MRC）的疗效量表。
共纳入39项研究。根据主要受区神经对疗效进行分类：正中神经、肌皮神经和桡神经/肱三头肌。关于总体功能恢复，11%的患者达到MRC M4级腕关节屈曲，38%的患者达到MRC M3级。7%的患者达到M4级手指屈曲，而36%的患者达到M3级。最后，56%的患者在正中神经支配区域的感觉恢复达到S3及以上。在肌皮神经组中，38%的患者恢复至M4级，37%的患者恢复至M3级。在桡神经/肱三头肌神经组中，分别有25%的患者将肘关节或腕关节伸展力量恢复至MRC M4级和M3级。
纳入研究中的疗效指标报告不一致，无法揭示CC7移位术给患者带来的真正益处。应使用可靠且经过验证的疗效评估工具对接受CC7移位术的患者进行严格评估。
