Division of Reconstructive Microsurgery, Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
J Reconstr Microsurg. 2024 Oct;40(8):611-618. doi: 10.1055/s-0044-1779720. Epub 2024 Feb 27.
Nerve transfers from one common donor nerve to recipient nerves with multiple target branches can yield slower and unpredictable recovery in the target nerves. Our hypothesis is that steal phenomenon exists when multiple nerve neurotization comes from one donor nerve.
In 30 Sprague-Dawley rats, the left ulnar nerve (UN) was selected as the donor nerve, and the musculocutaneous nerve (MCN) and median nerve (MN) as the recipient target nerves. The rats were separated into three groups (10 rats in each): group A, UN-to-MCN (one-target); group B, UN-to-MN (one-target); and group C, UN-to-MCN and MN (two-target). The right upper limbs were nonoperative as the control group. Outcome obtained at 20 weeks after surgery included grooming test, muscle weight, compound muscle action potential, tetanic muscle contraction force, axon counts, and retrograde labeling of the involved donor and target nerves.
At 20 weeks after surgery, muscles innervated by neurotization resulted in significant worse outcomes than the control side. This was especially true in two-target neurotization in the parameter of muscle weight and forearm flexor muscle contraction force outcome when compared to one-target neurotization. Steal phenomenon does exist because flexor muscle contraction force was significantly worse during two-target neurotization.
This study proves the existence of steal phenomenon in multiple target neurotization but does not significantly affect the functional results. Postoperative rehabilitative measures (including electrical stimulation, induction exercise) and patient compliance (ambition and persistence) are other crucial factors that hold equivalent importance to long-term successful recovery.
从一个共同供体神经向具有多个靶支的受体神经进行神经转移，可能导致靶神经的恢复缓慢且不可预测。我们的假设是，当多个神经神经化来自一个供体神经时，会存在盗血现象。
在 30 只 Sprague-Dawley 大鼠中，选择左侧尺神经（UN）作为供体神经，肌皮神经（MCN）和正中神经（MN）作为受体靶神经。大鼠分为三组（每组 10 只）：A 组，UN 至 MCN（一个靶）；B 组，UN 至 MN（一个靶）；C 组，UN 至 MCN 和 MN（两个靶）。右侧上肢作为非手术对照组。术后 20 周获得的结果包括梳理试验、肌肉重量、复合肌肉动作电位、强直肌肉收缩力、轴突计数以及供体和靶神经的逆行标记。
术后 20 周，神经化支配的肌肉的结果明显差于对照组。与单一神经化相比，双靶神经化在肌肉重量和前臂屈肌收缩力结果的参数中，这种情况更为明显。确实存在盗血现象，因为在双靶神经化时，屈肌收缩力明显更差。
本研究证明了在多个靶神经化中存在盗血现象，但对功能结果没有显著影响。术后康复措施（包括电刺激、诱导运动）和患者依从性（野心和坚持）是与长期成功恢复同等重要的其他关键因素。
