Rastrelli Marco, Tocco-Tussardi Ilaria, Tropea Saveria, Rossi Carlo Riccardo, Rizzato Sandro, Vindigni Vincenzo
Istituto Oncologico Veneto [Veneto Institute of Oncology], Via Gattamelata 64, 35128 Padova, Italy.
Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
Int J Surg Case Rep. 2018;51:58-61. doi: 10.1016/j.ijscr.2018.08.004. Epub 2018 Aug 9.
Femoral nerve lesions are uncommon but severely disrupting at the functional level, because of the inability to walk, run, and passing from sitting to standing position. Reconstruction via local nerve transfer (neurotization) is a relatively new yet promising procedure.
We describe a case of successful restoration of rectus femoris' function after a malignant process by transfer of the anterior branch of the obturator nerve at the thigh level. At present, only few similar reports are present in the literature. Nerve gap after surgery was considerable (10 cm) and nerve grafting could have been unsatisfactory in terms of reinnervation. Therefore, reconstruction was managed with nerve isolation and transfer to the rectus femoris motor branch. The functional result was satisfactory at 1-year follow up with margins for further improvement.
This case reported favorable outcomes of neurotization of the anterior branch of the obturator nerve for femoral nerve lesion. Reports of success with this procedure are still limited, but the promising results in terms of functional recovery suggest it should be offered to patients as a viable therapeutic option.
Advantages of neurotization compared to grafts are several, including: limiting suturing sites and scarring; shortening the recovery time by decreasing the required regeneration distance; and allowing for faster muscle reinnervation. The choice to transfer the anterior branch of the obturator nerve specifically allows to preserve part of the adductor functionality in the thigh without affecting the stability of the knee joint.
股神经损伤并不常见，但在功能层面上具有严重破坏性，因为患者无法行走、跑步以及从坐姿转换为站立姿势。通过局部神经移位（神经转位）进行重建是一种相对较新但很有前景的手术方法。
我们描述了一例通过在大腿水平转移闭孔神经前支成功恢复股直肌功能的病例，该病例此前经历了恶性病变过程。目前，文献中仅有少数类似报道。术后神经缺损相当大（10厘米），神经移植在再支配方面可能效果不佳。因此，通过神经分离并将其转移至股直肌运动支来进行重建。1年随访时功能结果令人满意，仍有进一步改善的空间。
该病例报告了闭孔神经前支神经转位治疗股神经损伤的良好结果。关于此手术成功的报道仍然有限，但在功能恢复方面的 promising results 表明，应将其作为一种可行的治疗选择提供给患者。
与移植相比，神经转位有几个优点，包括：限制缝合部位和瘢痕形成；通过减少所需的再生距离来缩短恢复时间；以及使肌肉再支配更快。选择转移闭孔神经前支特别能够保留大腿内收肌的部分功能，而不影响膝关节的稳定性。
