Institut de Chirurgie du Plexus Brachial et du Nerf Périphérique, 92, Boulevard de Courcelles, 75017 Paris, France.
Institut de Chirurgie du Plexus Brachial et du Nerf Périphérique, 92, Boulevard de Courcelles, 75017 Paris, France.
Hand Surg Rehabil. 2022 Feb;41S:S58-S62. doi: 10.1016/j.hansur.2018.03.009. Epub 2021 May 14.
Brachial plexus palsy after C8-T1 nerve root injury is rare, but causes a loss of finger flexion and extension, which greatly limits the patient's grip function. It can benefit from nerve transfers if the diagnosis is made early. Otherwise, tendon transfers may be proposed. Transfers of the extensor carpi radialis longus and brachioradialis to the flexor digitorum profundus and the flexor pollicis longus, respectively, restores finger flexion and thumb flexion. Tenodesis of the extensor digitorum communis allows passive extension of the fingers during active wrist flexion. Translocation of the flexor pollicis longus and the creation of a "lasso equivalent" on the flexor digitorum superficialis provides some recovery of the intrinsic function of the fingers and thumb. Finally, a nerve transfer of the lateral cutaneous nerve of forearm on the superficial branch of the ulnar nerve can improve sensitivity on the ulnar edge of the hand to limit the risk of cutaneous lesions, which frequently occur in this type of paralysis.
C8-T1 神经根损伤后臂丛神经瘫痪较为罕见，但会导致手指屈伸功能丧失，严重限制患者的握持功能。如果早期诊断，可进行神经转位治疗。否则，可能需要肌腱转位。通过将桡侧腕长伸肌和肱桡肌分别转移至指深屈肌和拇长屈肌，可以恢复手指和拇指的弯曲功能。通过指总伸肌腱固定术，在主动腕屈时可被动伸展手指。将拇长屈肌移位并在指浅屈肌上形成“套索等效物”，可部分恢复手指和拇指的内在功能。最后，通过将前臂外侧皮神经转移到尺神经浅支，可以改善手尺侧缘的敏感性，从而降低此类瘫痪患者经常发生的皮肤损伤风险。
