Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing 100191, China.
Chin Med J (Engl). 2017 Dec 20;130(24):2960-2968. doi: 10.4103/0366-6999.220316.
Root avulsion to all 5 roots of the brachial plexus is a common presentation and keeps a major reconstructive challenge. The contralateral C7 (CC7) nerve transfer has been used in treating brachial plexus avulsion injury (BPAI) since 1986. However, the effectiveness of the procedure remains a subject of controversy. The aim of this meta-analysis was to study surgical outcomes regarding motor and sensory recovery after CC7 nerve transfer.
Chinese or English (i.e., "contralateral c-7", "contralateral c7", "c7 nerve root", and "seventh cervical nerve root") keywords were used for a literature search for articles related to CC7 nerve transfer in several databases (i.e., PubMed, Cochrane, Embase, CNKI, CQVIP, and Wanfang Data). Clinical research articles were screened, and animal studies as well as duplicate publications were excluded. Muscle strength and sensory recovery were considered to be effective only when the scores on the United Kingdom Medical Research Council scale were equal to or higher than M3 and S3, respectively.
The overall ipsilateral recipient nerve recovery rates were as follows: the efficiency rate for muscle strength recovery after CC7 nerve transfer was 0.57 (95% confidence interval [CI]: 0.48-0.66) and for sensory recovery was 0.52 (95% CI: 0.46-0.58). When the recipient nerve was the median nerve, the efficiency rate for muscle strength recovery was 0.50 (95% CI: 0.39-0.61) and for sensory was 0.56 (95% CI: 0.50-0.63). When the recipient nerve was the musculocutaneous nerve and the radial nerve, the efficiency rate for muscle strength recovery was 0.74 (95% CI: 0.65-0.82) and 0.50 (95% CI: 0.31-0.70), respectively.
Transfer of CC7 nerves to musculocutaneous nerves leads to the best results. CC7 is a reliable donor nerve, which can be safely used for upper limb function reconstruction, especially for entirely BPAI. When modifying procedures, musculocutaneous nerves and median nerve can be combined as recipient nerves.
臂丛神经根全部 5 根撕脱伤较为常见，且具有很大的重建挑战性。自 1986 年以来，对侧 C7（CC7）神经转移已用于治疗臂丛神经撕脱伤（BPAI）。然而，该手术的效果仍存在争议。本荟萃分析旨在研究 CC7 神经转移术后运动和感觉恢复的手术效果。
中文或英文（即“对侧 C-7”、“对侧 C7”、“C7 神经根”和“第七颈神经根”）关键词用于在几个数据库（即 PubMed、Cochrane、Embase、CNKI、CQVIP 和万方数据）中搜索与 CC7 神经转移相关的文章。筛选临床研究文章，并排除动物研究和重复出版物。仅当英国医学研究理事会量表上的评分等于或高于 M3 和 S3 时，肌肉力量和感觉恢复才被认为是有效的。
同侧受神经恢复的总体效率如下：CC7 神经转移后肌肉力量恢复的有效率为 0.57（95%置信区间[CI]：0.48-0.66），感觉恢复的有效率为 0.52（95%CI：0.46-0.58）。当受神经为正中神经时，肌肉力量恢复的有效率为 0.50（95%CI：0.39-0.61），感觉恢复的有效率为 0.56（95%CI：0.50-0.63）。当受神经为肌皮神经和桡神经时，肌肉力量恢复的有效率分别为 0.74（95%CI：0.65-0.82）和 0.50（95%CI：0.31-0.70）。
CC7 神经转移至肌皮神经可获得最佳效果。CC7 是一种可靠的供体神经，可安全用于上肢功能重建，尤其是完全性 BPAI。在进行改良手术时，肌皮神经和正中神经可以作为受神经。
