Clinique Bizet, Institut de la Main, Paris, France.
Surg Radiol Anat. 2022 Feb;44(2):183-190. doi: 10.1007/s00276-021-02810-w. Epub 2021 Aug 18.
Nerve transfers represent an innovative tool in the surgical treatment of upper limb paralysis. Well-documented for brachial plexus sequalae and under evaluation for tetraplegic patients, they have not yet been described for spastic upper limbs. The typical spastic deformity involves active and spastic flexor, adductor and pronator muscles, associated with paralysed extensor and supinator muscles. Experience with selective neurectomy has shown an effective decrease in spasticity together with preservation of muscle strength. We conceptualized a combination of neurectomy and nerve transfer, by performing a partial nerve transfer from a spastic elbow flexor muscle to a paralyzed wrist extensor muscle, hypothesizing that this would reduce the spasticity of the former and simultaneously activate the latter.
Ten cadaveric dissections were performed in order to establish the anatomic feasibility of transferring a motor branch of the brachioradialis (BR) onto the branch of the extensor carpi radialis longus (ECRL) or brevis (ECRB). We measured the emergence, length, muscle entry point and diameter of each branch, and attempted the transfer.
We found 1-4 motor nerve for the BR muscle and 1-2 for the ECRL muscle. In all cases, the nerve transfer was achievable, allowing a satisfactory coaptation. The ECRB branch emerged too distally to be anastomosed to one of the BR branches.
This study shows that nerve transfers from the BR to the ECRL are anatomically feasible. It may open the way to an additional therapeutic approach for spastic upper limbs.
神经转移代表了上肢麻痹手术治疗的一种创新工具。神经转移已被广泛应用于治疗臂丛神经损伤后遗症，并正在评估其在四肢瘫痪患者中的应用，但尚未用于治疗痉挛性上肢。典型的痉挛性畸形涉及主动和痉挛性屈肌、内收肌和旋前肌，同时伴有瘫痪的伸肌和旋后肌。选择性神经切除术的经验表明，神经切除术可以有效降低痉挛程度，同时保持肌肉力量。我们设想通过从痉挛性肘屈肌中进行部分神经转移到瘫痪的腕伸肌来实现神经转移和神经转移的结合，假设这将减轻前者的痉挛程度，并同时激活后者。
为了确定将肱桡肌（BR）的运动支转移到桡侧伸腕长肌（ECRL）或短肌（ECRB）的分支上的解剖学可行性，我们进行了 10 例尸体解剖。我们测量了每个分支的出现、长度、肌肉进入点和直径，并尝试进行转移。
我们发现 BR 肌肉有 1-4 个运动神经，ECRL 肌肉有 1-2 个运动神经。在所有情况下，都可以进行神经转移，允许进行满意的吻合。ECRB 分支出现得太远，无法与 BR 分支之一吻合。
这项研究表明，BR 到 ECRL 的神经转移在解剖学上是可行的。它可能为痉挛性上肢提供一种额外的治疗方法。
