Politikou Olga, Harnoncourt Leopold, Fritsch Fabian, Maierhofer Udo, Tereshenko Vlad, Laengle Gregor, Festin Christopher, Luft Matthias, Gstoettner Clemens, Hirtler Lena, Aszmann Oskar C
Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna , Austria.
Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich , Switzerland.
Oper Neurosurg (Hagerstown). 2025 Apr 1;28(4):549-557. doi: 10.1227/ons.0000000000001339. Epub 2024 Sep 9.
Distal nerve transfers for muscle reinnervation and restoration of function after upper and lower motor neuron lesions are a well-established surgical approach. The brachialis to anterior interosseous nerve (BrAIN) transfer is performed for prehension reanimation in lower brachial plexus and traumatic cervical spinal cord injuries. The aim of the study is to shed light on the inconsistent results observed in patients who undergo the BrAIN transfer.
An anatomic dissection was conducted on 30 fresh upper limb specimens to examine the intraneural topography of the median nerve (MN) in the upper arm at the level of the BrAIN transfer and the presence of intraneural fascicular interconnections distally.
Fascicular interconnections between the AIN and other MN branches were consistently found in the distal third of the upper arm. The first interconnection was at 3.85 ± 1.82 cm proximal to the interepicondylar line, and the second one, after further proximal neurolysis, was at 9.45 ± 1.16 cm from the interepicondylar line. Intraneural topography of the AIN at the transfer level varied, with dorsomedial, dorsolateral, and purely dorsal locations observed.
Consistent fascicular interconnections between the AIN and MN branches and intraneural topography variability of the MN may lead to aberrant reinnervation.
在上、下运动神经元损伤后，采用远端神经移位术进行肌肉再支配和功能恢复是一种成熟的手术方法。肱肌至骨间前神经（BrAIN）移位术用于下臂丛神经损伤和创伤性颈脊髓损伤患者的抓握功能重建。本研究旨在阐明接受BrAIN移位术的患者中观察到的不一致结果。
对30个新鲜上肢标本进行解剖，以检查在BrAIN移位水平处上臂正中神经（MN）的神经内局部解剖结构，以及远端神经内束状连接的情况。
在上臂远端三分之一处始终发现骨间前神经（AIN）与正中神经其他分支之间存在束状连接。第一个连接位于肱骨髁间线近端3.85±1.82 cm处，在进一步近端神经松解后，第二个连接位于距肱骨髁间线9.45±1.16 cm处。移位水平处AIN的神经内局部解剖结构各不相同，观察到有背内侧、背外侧和纯背侧位置。
AIN与正中神经分支之间一致的束状连接以及正中神经神经内局部解剖结构的变异性可能导致异常的神经再支配。
