Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
J Hand Surg Am. 2023 Nov;48(11):1175.e1-1175.e10. doi: 10.1016/j.jhsa.2023.07.012. Epub 2023 Aug 18.
Contralateral C7 (CC7)-to-median nerve transfer has been commonly used to restore hand function in brachial plexus injury. To shorten the nerve graft, the prespinal route was described and achieved direct coaptation when combined with humeral shortening osteotomy. The limb was positioned at 0° shoulder abduction and neutral head position. Given our concern about donor-site morbidity when harvesting the whole CC7 nerve and tension across the neurorrhaphy site after mobilization, we aimed to describe our modified prespinal route and compare its outcomes and complications with the conventional hemi-CC7 transfer.
From 2004 to 2014, 39 patients with preganglionic total brachial plexus root avulsion injuries, with a minimum of 4 years of follow-up, were included. Overall, 20 and 19 patients underwent the conventional hemi-CC7-to-median nerve and hemi-CC7-to-lower trunk (LT) transfer through the modified prespinal route, respectively. The modified prespinal route was combined with bilateral clavicle shortening osteotomy to achieve direct coaptation to the LT at 45° shoulder abduction.
The modified prespinal route showed the median period to achieve ≥M3 hand grip assessed in clinical follow-up was shorter (26.5 months vs 45.5 months), and a higher proportion of patients achieved ≥M3 hand grip recovery (63% vs 30%). One patient experienced symptomatic phrenic nerve injury; however, the hemidiaphragm fully recovered after 6 months. The long-term donor-site complication rate was 2.6%, including one sensory abnormality, and no permanent donor-site weakness after hemi-CC7 harvesting was observed.
The modified prespinal route combined with clavicle osteotomy allowed direct coaptation to the LT and did not require head immobilization. It may allow a higher proportion of patients to achieve ≥M3 hand grip more quickly than conventional hemi-CC7 transfer.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
尺神经经颈 7（CC7）到正中神经转移术常用于治疗臂丛神经损伤后的手部功能恢复。为缩短神经移植长度，曾报道过经椎管前路的方法，该方法结合肱骨头缩短截骨术可实现直接吻合。将肢体置于 0°肩外展和中立头位。由于我们担心在采集整个 CC7 神经时供区的发病率，以及在动员后吻合部位的张力，我们旨在描述我们改良的椎管前路方法，并将其结果和并发症与传统的半 CC7 转移进行比较。
2004 年至 2014 年，我们纳入了 39 例节前全臂丛根撕脱伤患者，随访时间至少 4 年。总体而言，20 例和 19 例患者分别通过改良椎管前路进行了传统的半 CC7 到正中神经和半 CC7 到下干（LT）转移。改良椎管前路与双侧锁骨缩短截骨术相结合，可在 45°肩外展时实现与 LT 的直接吻合。
改良椎管前路的优势在于，从临床随访评估，实现≥M3 手抓握的中位时间更短（26.5 个月 vs 45.5 个月），且达到≥M3 手抓握恢复的患者比例更高（63% vs 30%）。1 例患者出现症状性膈神经损伤，但 6 个月后膈神经完全恢复。长期供区并发症发生率为 2.6%，包括 1 例感觉异常，且未观察到半 CC7 采集后出现永久性供区无力。
改良椎管前路结合锁骨截骨术可实现与 LT 的直接吻合，且不需要头部固定。与传统的半 CC7 转移相比，它可能使更高比例的患者更快地达到≥M3 手抓握。
研究类型/证据水平：治疗性 IV 级。
