Potter S M, Ferris S I
1 Victorian Plastic Surgery Unit, St Vincent's Private Hospital, East Melbourne, Victoria, Australia.
2 Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Prahan, Victoria, Australia.
J Hand Surg Eur Vol. 2017 Sep;42(7):693-699. doi: 10.1177/1753193417702029. Epub 2017 Apr 7.
We compared outcomes of primary vascularized ulnar nerve grafts from the C5 root neurotizing biceps and brachialis muscles, and gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve, as a primary or salvage procedure after complete brachial plexus injury. At 45 months, three of eight primary vascularized ulnar nerve graft patients regained grade 4 elbow flexion, while one regained grade 3. All 13 primary gracilis transfer patients regained grade 4 elbow flexion. Four patients with vascularized ulnar nerve grafts failed and subsequently had salvage functioning free muscle transfer procedures resulting in delayed recovery. Although vascularized ulnar nerve graft-based primary reconstructions can provide useful elbow flexion, this was achieved in less than half the cases. We consider primary gracilis functioning free muscle transfer neurotized by the distal spinal accessory nerve as the most reliable reconstruction for the restoration of elbow flexion in complete brachial plexus injury.
IV.
我们比较了将来自C5神经根的带血管蒂尺神经移植用于肱二头肌和肱肌神经化，以及将由远端副神经神经化的股薄肌进行游离肌肉移植作为全臂丛神经损伤后的初次或挽救手术的效果。在45个月时，8例接受初次带血管蒂尺神经移植的患者中有3例恢复了4级肘关节屈曲，1例恢复了3级。13例接受初次股薄肌移植的患者均恢复了4级肘关节屈曲。4例接受带血管蒂尺神经移植的患者手术失败，随后接受了挽救性游离肌肉移植手术，导致恢复延迟。尽管基于带血管蒂尺神经移植的初次重建可以提供有用的肘关节屈曲，但不到一半的病例能达到这一效果。我们认为由远端副神经神经化的初次股薄肌游离肌肉移植是全臂丛神经损伤后恢复肘关节屈曲最可靠的重建方法。
IV级。
