Gao Kai-Ming, Lao Jie, Guan Wen-Jie, Hu Jing-Jing
Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.
Nursing Department, Huashan Hospital, Fudan University, Shanghai, China.
Neural Regen Res. 2018 Jan;13(1):94-99. doi: 10.4103/1673-5374.224376.
If a partial contralateral C nerve is transferred to a recipient injured nerve, results are not satisfactory. However, if an entire contralateral C nerve is used to repair two nerves, both recipient nerves show good recovery. These findings seem contradictory, as the above two methods use the same donor nerve, only the cutting method of the contralateral C nerve is different. To verify whether this can actually result in different repair effects, we divided rats with right total brachial plexus injury into three groups. In the entire root group, the entire contralateral C root was transected and transferred to the median nerve of the affected limb. In the posterior division group, only the posterior division of the contralateral C root was transected and transferred to the median nerve. In the entire root + posterior division group, the entire contralateral C root was transected but only the posterior division was transferred to the median nerve. After neurectomy, the median nerve was repaired on the affected side in the three groups. At 8, 12, and 16 weeks postoperatively, electrophysiological examination showed that maximum amplitude, latency, muscle tetanic contraction force, and muscle fiber cross-sectional area of the flexor digitorum superficialis muscle were significantly better in the entire root and entire root + posterior division groups than in the posterior division group. No significant difference was found between the entire root and entire root + posterior division groups. Counts of myelinated axons in the median nerve were greater in the entire root group than in the entire root + posterior division group, which were greater than the posterior division group. We conclude that for the same recipient nerve, harvesting of the entire contralateral C root achieved significantly better recovery than partial harvesting, even if only part of the entire root was used for transfer. This result indicates that the entire root should be used as a donor when transferring contralateral C nerve.
如果将部分对侧C神经转移至受损伤的受体神经，效果并不理想。然而，如果使用整条对侧C神经来修复两条神经，两条受体神经均显示出良好的恢复情况。这些发现看似相互矛盾，因为上述两种方法使用的是同一条供体神经，只是对侧C神经的切断方式不同。为了验证这是否真的会导致不同的修复效果，我们将右侧全臂丛神经损伤的大鼠分为三组。在全根组中，切断对侧C神经根并将其转移至患肢的正中神经。在后侧支组中，仅切断对侧C神经根的后侧支并将其转移至正中神经。在全根+后侧支组中，切断对侧C神经根，但仅将后侧支转移至正中神经。神经切断术后，对三组患侧的正中神经进行修复。术后8周、12周和16周，电生理检查显示，全根组和全根+后侧支组的示指浅屈肌最大振幅、潜伏期、肌肉强直收缩力和肌纤维横截面积均明显优于后侧支组。全根组和全根+后侧支组之间未发现显著差异。正中神经有髓轴突计数全根组多于全根+后侧支组，全根+后侧支组多于后侧支组。我们得出结论，对于同一受体神经，获取对侧C神经全根比部分获取能显著实现更好的恢复，即使仅使用全根的一部分进行转移。这一结果表明，在转移对侧C神经时应使用全根作为供体。
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