缩短神经移植物和选择性受肌神经支对臂丛神经损伤患者屈肘神经移位手术的影响。
Effect of shorter nerve graft and selective motor branch of recipient nerve on nerve transfer surgery for elbow flexion in patients with brachial plexus injury.
机构信息
1School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand; and.
2Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
J Neurosurg. 2023 Mar 10;139(5):1405-1411. doi: 10.3171/2023.1.JNS222836. Print 2023 Nov 1.
OBJECTIVE
The spinal accessory nerve (SAN) is commonly used as a donor nerve for reinnervation of elbow flexors in brachial plexus injury (BPI) reconstruction. However, no study has compared the postoperative outcomes between SAN-to-musculocutaneous nerve (MCN) transfer and SAN-to-nerve to biceps (NTB) transfer. Thus, this study aimed to compare the postoperative time to recovery of elbow flexors between the two groups.
METHODS
A total of 748 patients who underwent surgical treatment for BPI between 1999 and 2017 were retrospectively reviewed. Among them, 233 patients were treated with nerve transfer for elbow flexion. Two techniques were used to harvest the recipient nerve: the standard dissection technique and the proximal dissection technique. The postoperative motor power of elbow flexion was assessed every month for 24 months using the Medical Research Council (MRC) grading system. Survival and Cox regression analyses were used to compare the time to recovery (MRC grade ≥ 3) between the two groups.
RESULTS
Of the 233 patients who underwent nerve transfer surgery, there were 162 patients in the MCN group and 71 patients in the NTB group. At 24 months after surgery, the MCN group had a success rate of 74.1%, and the NTB group had a success rate of 81.7% (p = 0.208). When compared with the MCN group, the NTB group had a significantly shorter median time to recovery (19 months vs 21 months, p = 0.013). Only 11.1% of patients in the MCN group regained MRC grade 4 or 5 motor power 24 months after nerve transfer surgery compared with 39.4% patients in the NTB group (p < 0.001). Cox regression analysis showed that the SAN-to-NTB transfer in combination with the proximal dissection technique was the only significant factor affecting time to recovery (HR 2.33, 95% CI 1.46-3.72; p < 0.001).
CONCLUSIONS
SAN-to-NTB transfer in combination with the proximal dissection technique is the preferred nerve transfer option for restoration of elbow flexion in traumatic pan-plexus palsy.
目的
副神经（SAN）通常被用作臂丛神经损伤（BPI）重建中肘部屈肌再支配的供体神经。然而，尚无研究比较 SAN 到肌皮神经（MCN）转移和 SAN 到二头肌神经（NTB）转移术后的结果。因此，本研究旨在比较两组患者肘部屈肌恢复的术后时间。
方法
回顾性分析 1999 年至 2017 年间接受手术治疗的 748 例 BPI 患者。其中，233 例患者接受神经转移术治疗肘部屈肌。采用两种技术获取受者神经：标准解剖技术和近端解剖技术。术后每月使用 Medical Research Council（MRC）分级系统评估肘部屈肌的运动力量，共 24 个月。采用生存分析和 Cox 回归分析比较两组患者的恢复时间（MRC 分级≥3）。
结果
在接受神经转移手术的 233 例患者中，MCN 组 162 例，NTB 组 71 例。术后 24 个月，MCN 组的成功率为 74.1%，NTB 组的成功率为 81.7%（p=0.208）。与 MCN 组相比，NTB 组的中位恢复时间明显更短（19 个月比 21 个月，p=0.013）。MCN 组术后 24 个月仅有 11.1%的患者恢复到 MRC 分级 4 或 5 的运动力量，而 NTB 组有 39.4%的患者恢复到 MRC 分级 4 或 5 的运动力量（p<0.001）。Cox 回归分析显示，SAN 到 NTB 转移结合近端解剖技术是影响恢复时间的唯一显著因素（HR 2.33，95%CI 1.46-3.72；p<0.001）。
结论
SAN 到 NTB 转移结合近端解剖技术是创伤性全臂丛神经损伤肘部屈肌恢复的首选神经转移方案。
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