Philadelphia Hand to Shoulder Center.
Shriners Hospital for Children, Philadelphia, PA.
J Pediatr Orthop. 2021 Jul 1;41(6):374-378. doi: 10.1097/BPO.0000000000001774.
The transfer of intraplexal and extraplexal nerves for restoration of function in children with traumatic and birth brachial plexus palsies has become well accepted. Little has been written about using the long thoracic nerve (LTN) as a donor in reanimation of the upper extremity. The authors present a case series of nerve transfers using the LTN as a donor in brachial plexus injury.
A retrospective chart review was performed over a 10-year period at a single institution. The primary outcome measure was the active movement scale.
Fourteen patients were included in the study: 10 birth injury patients and 4 blunt trauma patients. Average follow-up time was 21.3 and 10.75 months, respectively. The best outcomes were seen when the LTN was used for reinnervation of the obturator nerve in free functioning muscle transfers. The next most successful recipients were the musculocutaneous and axillary nerves. Outcomes were poor in transfers to the posterior interosseous fascicles of the radial nerve and the radial nerve branches to the triceps.
The LTN may be a potential nerve donor for musculocutaneous or axillary nerve reinnervation in patients with brachial plexus injuries when other donors are not available during a primary plexus reconstruction. However, the best use may be for delayed neurotization of a free functioning muscle transfer after the initial plexus reconstruction has failed and no other donors are available.
Level IV-therapeutic study.
为恢复创伤性和产伤臂丛神经病患儿的功能，人们已经普遍接受了将内神经束和外神经束转移。关于使用胸长神经（LTN）作为供体来重新支配上肢的功能，文献报道较少。作者介绍了使用 LTN 作为供体进行臂丛神经损伤神经转移的一系列病例。
在一家机构进行了为期 10 年的回顾性图表审查。主要的观察指标是主动运动量表。
本研究纳入了 14 例患者：10 例产伤患者和 4 例钝器伤患者。平均随访时间分别为 21.3 个月和 10.75 个月。当 LTN 用于游离功能肌肉转移中的闭孔神经再支配时，效果最佳。其次是肌皮神经和腋神经。用于桡神经后骨间神经束和肱三头肌桡神经分支的转位效果较差。
当在初次臂丛重建时没有其他供体时，LTN 可能是臂丛神经损伤患者肌皮神经或腋神经再支配的潜在神经供体。然而，其最佳用途可能是在初次臂丛重建失败且没有其他供体时，用于游离功能肌肉转移的延迟神经化。
IV 级治疗研究。
