一种新型双重神经转移术，用于恢复 C567 外伤性臂丛根撕脱伤患者的肩部功能和手部感觉恢复。

A novel dual nerve transfer for restoration of shoulder function and sensory recovery of the hand, in patients with C567 traumatic root avulsion of the brachial plexus.

机构信息

Peripheral Nerve and Brachial Plexus Surgery Unit, Department of Neurosurgery, Clinica Bolivariana, Universidad Pontificia Bolivariana School of Medicine, Medellin, Colombia.

Department of Pathology, University of Antioquia, Medellin, Colombia.

出版信息

Clin Neurol Neurosurg. 2021 Nov;210:107005. doi: 10.1016/j.clineuro.2021.107005. Epub 2021 Oct 23.

DOI:10.1016/j.clineuro.2021.107005

PMID:34741973

Abstract

OBJECTIVE

The objective of our study is to determine the anatomical viability in cadavers of a novel doble nerve transfer technique for simultaneous reanimation of shoulder abduction and sensory recovery of the hand, in patients with brachial plexus injuries sustaining a C5-C6-C7 roots avulsion. These new transfers should be complemented in the clinical setting with other classic nerve transfers, i.e.: (1) a spinal accessory to suprascapular for shoulder abduction and stability, (2) ulnar nerve fascicles to the biceps branches of the musculocutaneous for elbow flexion, and (3) intercostal to triceps branches for elbow extension.

METHODS

The proposed surgical technique includes (1) transferring motor fascicles of the median nerve (MNF), as donors to the axillary nerve (AN), and (2) the whole medial antebrachial cutaneous nerve (MACN) to the lateral contribution (sensory) of the median nerve (LCMN), both without the use of interposed nerve grafts. These techniques were performed in eight cadaveric upper extremities. Analyzed variables were: donor and receptor nerves diameter, length and distance of donor and receptors nerves, and axonal count.

RESULTS

The mean distance between the MNF and its point of coaptation to the AN was 19 mm. The average length of each one of the MNF, after distal dissection, was 46.5 mm. The average diameter of each fascicle of the median nerve at its coaptation point with the axillary nerve was 0.8 mm, while the average diameter of the latter was 3.9 mm. The average distance between the MACN and its point of coaptation to the LCMN, was 16.5 mm. The average diameter of the MACN and the LCMN at their point of coaptation, were 2.7 mm and 3.5 mm, respectively.

CONCLUSION

These nerve transfers are anatomically viable and could be a complement for other currently used techniques that can be employed in severely injured C567 brachial plexus patients.

摘要

目的

本研究的目的是确定一种新的双重神经转移技术在 C5-C6-C7 神经根撕脱伤的臂丛损伤患者中的解剖学可行性，该技术可同时实现肩部外展的再神经化和手部感觉恢复。在临床实践中，这些新的转移应与其他经典神经转移相结合，即：（1）副神经至肩胛上神经用于肩部外展和稳定性，（2）尺神经束至肌皮神经的二头肌分支用于肘部弯曲，（3）肋间神经至三头肌分支用于肘部伸展。

方法

所提出的手术技术包括（1）将正中神经（MNF）的运动束作为供体转移至腋神经（AN），以及（2）将整个前臂内侧皮神经（MACN）转移至正中神经的外侧分支（感觉）（LCMN），两者均不使用中间神经移植物。这些技术在 8 具尸体上肢中进行。分析的变量包括：供体和受体神经的直径、长度和距离，以及轴突计数。

结果

MNF 与其与 AN 吻合点之间的平均距离为 19mm。每一条 MNF 经远端解剖后的平均长度为 46.5mm。正中神经在与腋神经吻合处的每个束的平均直径为 0.8mm，而后者的平均直径为 3.9mm。MACN 与其与 LCMN 吻合点之间的平均距离为 16.5mm。MACN 和 LCMN 在吻合处的平均直径分别为 2.7mm 和 3.5mm。