Cao Yu, Li Yuehong, Zhang Youlai, Li Shulin, Jiang Junjian, Gu Yudong, Xu Lei
Ningbo Ninth Hospital, Ningbo, Zhejiang Province, China.
Ann Plast Surg. 2020 May;84(5S Suppl 3):S171-S177. doi: 10.1097/SAP.0000000000002371.
Femoral nerve palsy can cause loss in quadriceps function and knee extension disability, which may lead to severe lower extremity impairment. The obturator nerve trunk transfer in the pelvic, the obturator nerve mortal branches transfer out of the pelvic, along with nerve graft, was introduced years ago to restore femoral nerve function. However, the outcomes of these procedures have never been compared. The aims of this study were to give our experiences in surgical reconstruction for femoral nerve injury and to compare the outcomes of different approaches.
Nine patients with complete femoral nerve injury have been enrolled in this study between March 2012 and July 2016. All patients were followed up for at least 2 years after surgical intervention for sural nerve graft (n = 3), obturator trunk transfer in the pelvic (n = 2), or obturator nerve mortal branches transfer out of the pelvic (n = 4).
All patients gained satisfactory quadriceps Medical Research Council grade (M3-M4+) after more than 2 years of follow-up. The sural nerve graft led to the earliest recovery on average, followed by obturator nerve mortal branches transfer in the thigh level and then obturator nerve trunk transfer in the pelvic. The functional outcomes, demonstrated by Lower Extremity Functional Scale and Femoral Nerve Motor Function Scale scores, also showed that the sural nerve graft was the best on average, followed by obturator nerve trunk transfer in the pelvic and then obturator nerve mortal branches transfer in the thigh level.
Our results indicate that all these 3 procedures are safe and reliable ways to reconstruct femoral nerve function and can be applied to patients with different kinds of injuries. The sural nerve graft should be considered in the first place and the obturator nerve transfer at different level (trunk transfer in the pelvic or mortal branches transfer out of the pelvic) can be performed as the alternative.
股神经麻痹可导致股四头肌功能丧失和膝关节伸展障碍，这可能会导致严重的下肢功能受损。多年前引入了盆腔内闭孔神经干移位、盆腔外闭孔神经终末支移位以及神经移植等方法来恢复股神经功能。然而，这些手术的效果从未被比较过。本研究的目的是分享我们在股神经损伤手术重建方面的经验，并比较不同方法的效果。
2012年3月至2016年7月期间，9例股神经完全损伤患者纳入本研究。所有患者在接受腓肠神经移植（n = 3）、盆腔内闭孔神经干移位（n = 2）或盆腔外闭孔神经终末支移位（n = 4）手术干预后至少随访2年。
经过2年多的随访，所有患者的股四头肌医学研究委员会分级（M3 - M4 +）均令人满意。平均而言，腓肠神经移植导致恢复最早，其次是大腿水平的闭孔神经终末支移位，然后是盆腔内闭孔神经干移位。下肢功能量表和股神经运动功能量表评分所显示的功能结果也表明，平均而言，腓肠神经移植效果最佳，其次是盆腔内闭孔神经干移位，然后是大腿水平的闭孔神经终末支移位。
我们的结果表明，这三种手术都是重建股神经功能的安全可靠方法，可应用于不同类型损伤的患者。应首先考虑腓肠神经移植，不同水平的闭孔神经移位（盆腔内干移位或盆腔外终末支移位）可作为替代方法。
