Feng Juntao, Wang Tao, Luo Pengbo
Department of Orthopedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 185, Pu An Road, Shanghai, China.
Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China.
J Orthop Surg Res. 2019 Jan 23;14(1):27. doi: 10.1186/s13018-019-1068-2.
Restoration of hand function after total brachial plexus root avulsion (tBPRA) is a difficult problem in surgical management. A new modified approach in repairing tBPRA is to use a subcutaneous tunnel across the anterior surface of the chest and neck, and then transfer the contralateral C7 root (cC7) to the lower trunk. However, the anatomical details of this method have not yet been fully described and assessed. The objective of this study was to quantitatively describe the nerve transfer using a cadaveric surgical simulation.
Brachial plexuses were dissected from 12 adult cadavers, producing 24 sides of brachial plexuses for nerve transfer experiments. We performed simulated cC7 transfers to the lower trunk via a subcutaneous tunnel across the anterior surface of the chest and neck. Measurements of the nerves were made and transfers quantitatively documented.
With the affected shoulder and arm in a neutral position, cC7 and C8-T1 could be sutured directly together in 75% of the cadavers. A nerve graft length of 4.6 ± 1.18 cm was needed to bridge the gap in the remaining cadavers. For cadavers where distal cC7 was directly connected with the lower trunk, 54.17% could be sutured, and an average nerve graft length of 3.9 cm was needed in the remains.
For surgical management of total tBPRA, transfer of the cC7 nerve to the C8-T1 or lower trunk via a subcutaneous tunnel across the chest and neck will likely be superior to a conventional cC7 root transfer in the clinic. This approach shortens the nerve graft needed and nerve regeneration distance, decreases the number of neurorrhaphy sites, and makes full use of the donor nerves, which may benefit hand flexion restoration.
全臂丛神经根性撕脱伤（tBPRA）后手功能的恢复是外科治疗中的一个难题。一种修复tBPRA的新改良方法是通过横跨胸部和颈部前表面的皮下隧道，然后将对侧C7神经根（cC7）转移至下干。然而，该方法的解剖细节尚未得到充分描述和评估。本研究的目的是通过尸体手术模拟定量描述神经移位。
从12具成年尸体上解剖臂丛神经，获得24侧臂丛神经用于神经移位实验。我们通过横跨胸部和颈部前表面的皮下隧道进行模拟的cC7向下干的移位。对神经进行测量并对移位进行定量记录。
在患侧肩部和手臂处于中立位时，75%的尸体中cC7和C8 - T1可直接缝合在一起。其余尸体需要4.6±1.18 cm的神经移植物来桥接间隙。对于远端cC7直接与下干相连的尸体，54.17%可进行缝合，其余尸体平均需要3.9 cm的神经移植物。
对于全tBPRA的外科治疗，通过横跨胸部和颈部的皮下隧道将cC7神经转移至C8 - T1或下干在临床上可能优于传统的cC7神经根转移。这种方法缩短了所需的神经移植物长度和神经再生距离，减少了神经缝合部位的数量，并充分利用了供体神经，这可能有利于手部屈曲功能的恢复。
