Hong Guang-Hui, Liu Jing-Bo, Liu Yu-Zhou, Gao Kai-Ming, Zhao Xin, Lao Jie
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.
Neural Regen Res. 2019 Aug;14(8):1449-1454. doi: 10.4103/1673-5374.253530.
Contralateral C7 nerve transfer surgery is one of the most important surgical techniques for treating total brachial plexus nerve injury. In the traditional contralateral C7 nerve transfer surgery, the whole ulnar nerve on the paralyzed side is harvested for transfer, which completely sacrifices its potential of recovery. In the present, novel study, we report on the anatomical feasibility of a modified contralateral C7 nerve transfer surgery. Ten fresh cadavers (4 males and 6 females) provided by the Department of Anatomy, Histology, and Embryology at the Medical College of Fudan University, China were used in modified contralateral C7 nerve transfer surgery. In this surgical model, only the dorsal and superficial branches of the ulnar nerve and the medial antebrachial cutaneous nerve on the paralyzed side (left) were harvested for grafting the contralateral (right) C7 nerve and the recipient nerves. Both the median nerve and deep branch of the ulnar nerve on the paralyzed (left) side were recipient nerves. To verify the feasibility of this surgery, the distances between each pair of coaptating nerve ends were measured by a vernier caliper. The results validated that starting point of the deep branch of ulnar nerve and the starting point of the medial antebrachial cutaneous nerve at the elbow were close to each other and could be readily anastomosed. We investigated whether the fiber number of donor and recipient nerves matched one another. The axons were counted in sections of nerve segments distal and proximal to the coaptation sites after silver impregnation. Averaged axon number of the ulnar nerve at the upper arm level was approximately equal to the sum of the median nerve and proximal end of medial antebrachial cutaneous nerve (left: 0.94:1; right: 0.93:1). In conclusion, the contralateral C7 nerve could be transferred to the median nerve but also to the deep branch of the ulnar nerve via grafts of the ulnar nerve without deep branch and the medial antebrachial cutaneous nerve. The advantage over traditional surgery was that the recovery potential of the deep branch of ulnar nerve was preserved. The study was approved by the Ethics Committee of Fudan University (approval number: 2015-064) in July, 2015.
对侧C7神经移位术是治疗全臂丛神经损伤最重要的外科技术之一。在传统的对侧C7神经移位术中，需切取瘫痪侧的整条尺神经用于移位，这完全牺牲了其恢复潜力。在本项新研究中，我们报告了改良对侧C7神经移位术的解剖学可行性。采用中国复旦大学医学院解剖学、组织学与胚胎学系提供的10具新鲜尸体（4例男性和6例女性）进行改良对侧C7神经移位术。在该手术模型中，仅切取瘫痪侧（左侧）尺神经的背侧支、浅支及前臂内侧皮神经用于移植对侧（右侧）C7神经及受区神经。瘫痪侧（左侧）的正中神经和尺神经深支均为受区神经。为验证该手术的可行性，用游标卡尺测量每对吻合神经断端之间的距离。结果证实，尺神经深支起点与前臂内侧皮神经在肘部的起点彼此接近，易于吻合。我们研究了供体神经与受体神经的纤维数量是否匹配。在银染后，对吻合部位远端和近端的神经节段切片中的轴突进行计数。上臂水平尺神经的平均轴突数量约等于正中神经与前臂内侧皮神经近端的总和（左侧：0.94:1；右侧：0.93:1）。总之，对侧C7神经可通过不带深支的尺神经及前臂内侧皮神经移植至正中神经，也可移植至尺神经深支。相对于传统手术的优势在于保留了尺神经深支的恢复潜力。本研究于2015年7月获得复旦大学伦理委员会批准（批准文号：2015 - 064）。
