Zhao Hua-Li, Gao Yun, Yu Ai-Ping, Wei Yi-Min, Shen Yun-Dong, Jiang Su, Qiu Yan-Qun, Yu Jing, Liang Zong-Hui
Department of Radiology, Jing'an District Central Hospital, Shanghai, China.
Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Shanghai, China.
Front Surg. 2022 Jun 29;9:837872. doi: 10.3389/fsurg.2022.837872. eCollection 2022.
The prespinal route of contralateral cervical 7 nerve transfer developed by Prof. Wendong Xu helps realize the direct anastomosis of the bilateral cervical 7 nerves. However, 20% of operations still require a nerve graft, which leads to an unfavorable prognosis. This study aims to explore the optimized prespinal route with MRI to further improve the prognosis.
The current study enrolled 30 patients who suffered from central spastic paralysis of an upper limb and who underwent contralateral cervical 7 nerve transfer via Prof. Xu's prespinal route through the anterior edge of the contralateral longus colli. MRI images were used to analyze the route length, vertebral artery exposure, and contralateral cervical 7 nerve included angle. Three prespinal routes were virtually designed and analyzed. The selected optimal route was applied to another 50 patients with central spastic paralysis of an upper limb for contralateral cervical 7 nerve transfer.
By the interventions on the 30 patients, the middle and posterior routes were shorter than the anterior route in length, but with no statistical difference between the two routes. Of 30 contralateral vertebral arteries, 26 were located at the posterior medial edge of the longus colli. The average included angles of the anterior, middle, and posterior routes were 108.02 ± 7.89°, 95.51 ± 6.52°, and 72.48 ± 4.65°, respectively. According to these data, the middle route was optimally applied to 50 patients, in whom the rate of nerve transplantation was only 4%, and no serious complications such as vertebral artery or brachial plexus injury occurred.
The low rate of nerve transplantation in 50 patients and the absence of any serious complications in these cases suggests that the middle route is the optimal one.
徐文东教授所开创的颈7神经交叉移位的椎前入路有助于实现双侧颈7神经的直接吻合。然而，仍有20%的手术需要神经移植，这导致预后不佳。本研究旨在通过磁共振成像（MRI）探索优化的椎前入路，以进一步改善预后。
本研究纳入30例上肢中枢性痉挛性瘫痪患者，这些患者通过徐教授的经对侧颈长肌前缘的椎前入路接受了颈7神经交叉移位手术。利用MRI图像分析入路长度、椎动脉暴露情况以及对侧颈7神经夹角。虚拟设计并分析了三条椎前入路。将选定的最佳入路应用于另外50例上肢中枢性痉挛性瘫痪患者进行颈7神经交叉移位。
对30例患者进行干预后，中路和后路的长度短于前路，但两者之间无统计学差异。30条对侧椎动脉中，26条位于颈长肌后内侧缘。前路、中路和后路的平均夹角分别为108.02±7.89°、95.51±6.52°和72.48±4.65°。根据这些数据，中路被最佳地应用于50例患者，其中神经移植率仅为4%，且未发生椎动脉或臂丛神经损伤等严重并发症。
50例患者的神经移植率低且未出现任何严重并发症，表明中路是最佳入路。
