McGrath Aleksandra M, Lu Johnny Chuieng-Yi, Chang Tommy Naj-Jen, Fang Frank, Chuang David Chwei-Chin
Department of Hand and Plastic Surgery, Norrland's University Hospital, Umeå, Sweden; Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden; and Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei-Linkou, Taiwan.
Plast Reconstr Surg Glob Open. 2016 Dec 13;4(12):e1130. doi: 10.1097/GOX.0000000000001130. eCollection 2016 Dec.
The exact role of proximal and distal nerve transfers in reconstruction strategies of brachial plexus injury remains controversial. We compared proximal with distal nerve reconstruction strategies in a rat model of brachial plexus injury.
In rats, the C6 spinal nerve with a nerve graft (proximal nerve transfer model, n = 30, group A) and 50% of ulnar nerve (distal nerve transfer model, n = 30, group B) were used as the donor nerves. The targets were the musculocutaneous nerve and the biceps muscle. Outcomes were recorded at 4, 8, 12, and 16 weeks postoperatively. Outcome parameters included grooming test, biceps muscle weight, compound muscle action potentials, tetanic contraction force, and axonal morphology of the donor and target nerves.
The axonal morphology of the 2 donor nerves revealed no significant difference. Time interval analysis in the proximal nerve transfer group showed peak axon counts at 12 weeks and a trend of improvement in all functional and physiologic parameters across all time points with statistically significant differences for grooming test, biceps compound action potentials, tetanic muscle contraction force, and muscle weight at 16 weeks. In contrast, in the distal nerve transfer group, the only statistically significant difference was observed between the 4 and 8 week time points, followed by a plateau from 8 to 16 weeks.
Outcomes of proximal nerve transfers are ultimately superior to distal nerve transfers in our experimental model. Possible explanations for the superior results include a reduced need for cortical adaptation and higher proportions of motor units in the proximal nerve transfers.
在臂丛神经损伤的重建策略中，近端和远端神经移位的确切作用仍存在争议。我们在大鼠臂丛神经损伤模型中比较了近端与远端神经重建策略。
在大鼠中，将带有神经移植物的C6脊神经（近端神经移位模型，n = 30，A组）和50%的尺神经（远端神经移位模型，n = 30，B组）用作供体神经。目标是肌皮神经和肱二头肌。在术后4、8、12和16周记录结果。结果参数包括梳理试验、肱二头肌重量、复合肌肉动作电位、强直收缩力以及供体和目标神经的轴突形态。
两条供体神经的轴突形态无显著差异。近端神经移位组的时间间隔分析显示，轴突计数在12周时达到峰值，并且在所有时间点所有功能和生理参数均有改善趋势，在16周时梳理试验、肱二头肌复合动作电位、肌肉强直收缩力和肌肉重量有统计学显著差异。相比之下，在远端神经移位组中，仅在4周和8周时间点之间观察到统计学显著差异，随后在8至16周出现平台期。
在我们的实验模型中，近端神经移位的结果最终优于远端神经移位。结果更好的可能解释包括对皮质适应的需求减少以及近端神经移位中运动单位的比例更高。
