Maincourt P, Ramiere J, Seizeur R, Hu W, Perruisseau-Carrier A
Service de chirurgie plastique, reconstructrice et esthétique, CHRU de Brest, hôpital de la Cavale-Blanche, Brest, France.
Service de chirurgie orthopédique, HIA Clermont Tonnerre Brest, rue Colonel-Fontferrier, 29240 Brest cedex, France.
Ann Chir Plast Esthet. 2024 Sep;69(5):343-354. doi: 10.1016/j.anplas.2024.07.005. Epub 2024 Aug 5.
Upper limb spasticity is a surgical challenge, both in diminishing agonists spasticity and reconstructing antagonist function. Brachioradialis (BR) is often involved in elbow flexors spasticity. Finger extension is often impaired in spastic patients. This study aims to demonstrate the feasibility of BR motor branch to posterior interosseous nerve (PIN) during BR selective neurectomies, and to describe fascicles topography inside the radial nerve to facilitate PIN dissection.
Ten upper limbs from 10 fresh frozen anatomical specimens were dissected. Motor branches to the BR, wrist extensors, supinator, PIN and radial sensory branch were identified. BR to PIN transfer was realized and its feasibility was studies (donor length, tensionless suture).
BR to PIN transfer was achievable in 9 out of 10 cases. The position of the sensory branch of the radial nerve was inferior or medial in all cases. The position of the PIN was lateral in 90% of the cases.
BR to PIN nerve transfer is achievable in most cases (90%). The lateral topography of the PIN and the inferomedial topography of the sensory branch in most cases allows for an easier intraoperative finding of the PIN when stimulation is not possible.
IV, feasibility study.
上肢痉挛是一项手术挑战，既要减轻主动肌痉挛，又要重建拮抗肌功能。肱桡肌（BR）常参与肘部屈肌痉挛。痉挛患者的手指伸展功能常受损。本研究旨在证明在肱桡肌选择性神经切除术期间，将肱桡肌运动支转移至骨间后神经（PIN）的可行性，并描述桡神经内的束支形态以利于骨间后神经的解剖。
对10个新鲜冷冻解剖标本的10条上肢进行解剖。识别出肱桡肌、腕伸肌、旋后肌、骨间后神经和桡神经感觉支的运动支。完成了肱桡肌至骨间后神经的转移并研究了其可行性（供体长度、无张力缝合）。
10例中有9例可实现肱桡肌至骨间后神经的转移。桡神经感觉支的位置在所有病例中均位于下方或内侧。90%的病例中骨间后神经的位置位于外侧。
大多数病例（90%）可实现肱桡肌至骨间后神经的神经转移。在大多数情况下，骨间后神经的外侧位置以及感觉支的下内侧位置使得在无法进行刺激时更容易在术中找到骨间后神经。
IV级，可行性研究。
