1Department of Surgery, Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, Virginia; and.
2Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan.
J Neurosurg. 2023 Oct 20;140(4):1102-1109. doi: 10.3171/2023.8.JNS23803. Print 2024 Apr 1.
Nerve reconstruction after 6 months of denervation time in brachial plexus injuries (BPIs) can be inconsistent. A dilemma exists when the use of critical donor nerves for nerve transfers may lead to unreliable outcomes that would waste the donor nerve. The purpose of this study was to evaluate the long-term outcomes of elbow and shoulder function in patients with BPIs receiving nerve reconstruction in the delayed setting (i.e., 6-12 months after injury).
Data from patients with delayed BPIs who received a nerve transfer (including proximal and distal nerve transfer/grafting) at a tertiary medical center were retrospectively collected from January 1999 to March 2020. Demographics, extent of injury, mechanism of injury, and reconstructive methods were collected. Patients were categorized into two groups: non-pan-plexus BPI (C5-6, C5-7, and C5-8) and pan-plexus BPI (C5-T1). Acceptable outcome was defined as elbow flexion ≥ M3 status or shoulder abduction ≥ 60°.
Sixty-four patients were included in the study. The average time from injury to nerve reconstruction was 236 (range 180-441) days, and the average follow-up time was 66 months. In the non-pan-plexus BPI group (n = 43 patients), 74.4% of patients demonstrated M3 elbow flexion, and 48.8% of patients demonstrated M4 elbow flexion. Double fascicular transfer yielded better results and faster recovery than a single fascicular transfer. In the pan-plexus BPI group (n = 21 patients), 38.1% of patients reached M3 elbow flexion and 23.8% attained M4 elbow flexion. In the non-pan-plexus BPI group, the recovery rate of acceptable shoulder abduction was 53.5%, but only 23.5% of pan-plexus patients with BPI achieved acceptable shoulder abduction.
Nerve reconstruction can effectively restore functional elbow flexion and acceptable shoulder abduction in non-pan-plexus patients with BPI in the delayed setting. However, neither acceptable elbow flexion nor shoulder abduction could be consistently achieved in pan-plexus BPI. Judicious use of the donor nerves in pan-plexus injuries is required, in addition to preserving a donor nerve for a backup plan such as free-functioning muscle transplantation or tendon transfers.
臂丛神经损伤（BPIs）后神经失用 6 个月进行神经重建的效果可能并不稳定。如果使用关键供体神经进行神经转移，可能会导致不可靠的结果，从而浪费供体神经，此时就存在一个困境。本研究旨在评估在延迟期（即损伤后 6-12 个月）接受神经重建的 BPIs 患者的肘部和肩部功能的长期结果。
回顾性收集 1999 年 1 月至 2020 年 3 月在一家三级医疗中心接受神经转移（包括近端和远端神经转移/移植）的延迟性 BPIs 患者的数据。收集人口统计学、损伤程度、损伤机制和重建方法等数据。患者分为两组：非全臂丛神经损伤（C5-6、C5-7 和 C5-8）和全臂丛神经损伤（C5-T1）。可接受的结果定义为肘部屈曲≥M3 状态或肩部外展≥60°。
本研究纳入了 64 名患者。从损伤到神经重建的平均时间为 236（180-441）天，平均随访时间为 66 个月。在非全臂丛神经损伤组（n=43 例）中，74.4%的患者肘部屈曲达到 M3 状态，48.8%的患者肘部屈曲达到 M4 状态。双束神经转移比单束神经转移效果更好，恢复更快。在全臂丛神经损伤组（n=21 例）中，38.1%的患者肘部屈曲达到 M3 状态，23.8%的患者肘部屈曲达到 M4 状态。在非全臂丛神经损伤组中，可接受的肩部外展恢复率为 53.5%，但全臂丛神经损伤患者中只有 23.5%达到可接受的肩部外展。
在延迟期，神经重建可有效恢复非全臂丛神经损伤患者的肘部功能和可接受的肩部外展。然而，全臂丛神经损伤患者既无法获得可接受的肘部屈曲，也无法获得可接受的肩部外展。对于全臂丛神经损伤，需要谨慎使用供体神经，同时保留供体神经作为备用方案，如游离功能肌肉移植或肌腱转移。
