From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center; the Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic; and Xpert Clinic, Hand and Wrist Surgery.
Plast Reconstr Surg. 2019 Jul;144(1):155-166. doi: 10.1097/PRS.0000000000005720.
Elbow flexion after upper brachial plexus injury may be restored by a nerve transfer from the ulnar nerve to the biceps motor branch with an optional nerve transfer from the median nerve to the brachialis motor branch (single and double fascicular nerve transfer). This meta-analysis assesses the effectiveness of both techniques and the added value of additional reinnervation of the brachialis muscle.
Comprehensive searches were performed identifying studies concerning restoration of elbow flexion through single and double fascicular nerve transfers. Only C5 to C6 lesion patients were included in quantitative analysis to prevent confounding by indication. Primary outcome was the proportion of patients reaching British Medical Research Council elbow flexion grade 3 or greater. Meta-analysis was performed with random effects models.
Thirty-five studies were included (n = 688). In quantitative analysis, 29 studies were included (n = 341). After single fascicular nerve transfer, 190 of 207 patients reached Medical Research Council grade 3 or higher (random effects model, 95.6 percent; 95 percent CI, 92.9 to 98.2 percent); and after double fascicular nerve transfer, 128 of 134 patients reached grade 3 or higher (random effects model, 97.5 percent; 95 percent CI, 95.0 to 100 percent; p = 0.301). Significantly more double nerve transfer patients reached grade 4 or greater if preoperative delay was 6 months or less (84 of 101 versus 49 of 51; p = 0.035).
Additional reinnervation of the brachialis muscle did not result in significantly more patients reaching Medical Research Council grade 3 or higher for elbow flexion. Double fascicular nerve transfer may result in more patients reaching grade 4 or higher in patients with a preoperative delay less than 6 months. The median nerve may be preserved or used for another nerve transfer without substantially impairing elbow flexion restoration.
通过尺神经至二头肌运动支的神经转移，联合正中神经至肱肌运动支的可选神经转移，可以恢复上肢臂丛神经损伤后的肘部屈曲。本荟萃分析评估了这两种技术的有效性，以及肱肌的附加神经再支配的附加价值。
全面检索了恢复肘部屈曲的单神经束和双神经束神经转移的相关研究。仅纳入 C5 至 C6 病变患者进行定量分析，以防止混杂因素。主要结局是达到英国医学研究理事会肘部屈曲 3 级或以上的患者比例。采用随机效应模型进行荟萃分析。
共纳入 35 项研究（n=688）。定量分析纳入 29 项研究（n=341）。单神经束神经转移后，207 例患者中有 190 例达到英国医学研究理事会 3 级或以上（随机效应模型，95.6%；95%置信区间，92.9%至 98.2%）；双神经束神经转移后，134 例患者中有 128 例达到 3 级或以上（随机效应模型，97.5%；95%置信区间，95.0%至 100%；p=0.301）。如果术前延迟时间为 6 个月或更短，则双神经束转移患者达到 4 级或以上的比例显著更高（84 例中有 101 例，而 49 例中有 51 例；p=0.035）。
肱肌的附加神经再支配并没有显著增加达到英国医学研究理事会肘部屈曲 3 级或以上的患者比例。对于术前延迟时间小于 6 个月的患者，双神经束神经转移可能会使更多患者达到 4 级或以上。在不明显影响肘部屈曲恢复的情况下，可以保留或使用正中神经进行另一神经转移。
