Li Liang, He Wen-Ting, Qin Ben-Gang, Liu Xiao-Lin, Yang Jian-Tao, Gu Li-Qiang
Department of Orthopedic Trauma and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Neural Regen Res. 2019 Dec;14(12):2132-2140. doi: 10.4103/1673-5374.262600.
Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system; meaningful recovery was defined as M3-M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID: [2017] 290) on November 14, 2017.
将对侧C7直接与上干进行端端吻合可避免神经移植。我们成功缩短了间隙和移植长度，甚至实现了直接端端吻合。然而，直接修复仅能在部分特定病例中进行，部分手术仍需自体移植，自体移植是修复神经缺损的金标准。由于自体移植后常出现症状，已使用人脱细胞神经异体移植来避免相关症状。本研究调查了直接修复和脱细胞异体移植后肩外展和肘屈曲的质量，以评估臂丛神经损伤修复中需要关注的问题。手术数据库中的51例臂丛神经损伤患者符合本回顾性研究的条件。根据不同手术方法将患者分为两组。27例患者进行了直接修复，24例患者使用脱细胞神经异体移植来桥接对侧C7神经根与上干之间的间隙。术中测量所取对侧C7神经根的长度。根据英国医学研究委员会评分系统检查三角肌和肱二头肌肌力以及肩外展和肘屈曲的度数；有意义的恢复定义为M3 - M5。直接修复组对侧C7前后分支的长度分别为7.64±0.69mm和7.55±0.69mm，脱细胞神经异体移植组分别为6.46±0.58mm和6.43±0.59mm。经过至少4年的随访，直接修复组三角肌和肱二头肌有意义的恢复率分别为88.89%和85.19%，而脱细胞神经异体移植组分别为70.83%和66.67%。与脱细胞神经异体移植组相比，直接修复组C5/C6再支配的时间更短。直接修复有助于肩外展和肘屈曲的恢复。因此，如果无法进行直接端端吻合，使用脱细胞神经异体移植是一个合适的选择。本研究于2017年11月14日获得中国中山大学附属第一医院医学伦理委员会批准（申请编号：[2017]290）。
