OU Traumatology-Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Torino, Italy.
OU Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy.
Injury. 2020 Dec;51(12):2904-2909. doi: 10.1016/j.injury.2020.03.015. Epub 2020 Mar 19.
Closed brachial plexus lesions (BPLs) are generally associated with a traumatic mechanism of forced traction between the neck and the shoulder-arm complex. For brachial plexus reconstruction different techniques have been proposed with donor motor nerves like intercostal nerves, or the ipsilateral cervical plexus, the phrenic nerve, the contralateral C7 root, and many others. Despite all these surgical possibilities, the overall recovery is generally poor and not satisfactory. The principal drawback is linked to the loss of upper limb proprioception, in a way that dramatically influences even a good motor recovery, so in complete BPLs the sensory loss still represents a debilitating problem. In this anatomical feasibility study, the possibility to transfer the peroneal component of the sciatic nerve as a donor for complete BPLs has been evaluated. This technique would conceptually bring an important motor and sensory contribution to the upper limb using pure motor and sensory branches of the sciatic nerve. Performing immediate tendon transfer for foot drop palsy could significantly decrease the morbidity of the surgical procedure.
闭孔臂丛神经损伤（BPL）通常与颈部和肩臂复合体之间强制牵引的创伤机制有关。对于臂丛神经重建，已经提出了不同的技术，包括供体运动神经，如肋间神经或同侧颈丛神经、膈神经、对侧 C7 神经根和许多其他神经。尽管有所有这些手术可能性，但总体恢复通常较差，不能令人满意。主要的缺点与上肢本体感觉的丧失有关，这种丧失甚至严重影响了良好的运动恢复，因此在完全 BPL 中，感觉丧失仍然是一个使人虚弱的问题。在这项解剖可行性研究中，评估了将坐骨神经的腓肠神经成分作为完全 BPL 的供体的可能性。这种技术将使用坐骨神经的纯运动和感觉分支为上肢提供重要的运动和感觉贡献。对于足下垂麻痹，立即进行肌腱转移可以显著降低手术的发病率。
