Mitchell Eric C, Mansouri Mehran, Miller Thomas, Ross Douglas, Gillis Joshua
Department of Surgery, Western University, London, Ontario, Canada.
Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada.
Hand (N Y). 2024 Nov 6:15589447241286263. doi: 10.1177/15589447241286263.
The "supercharge" end-to-side (SETS) anterior-interosseous-nerve (AIN) to ulnar-motor nerve transfer is used to improve intrinsic muscle recovery in cases of severe ulnar nerve compression or proximal axonotmetic injuries. Previous work has found differing intrinsic muscle recovery after this transfer. The objectives of this study were to examine the patterns of recovery in first dorsal interossei (FDI) and abductor digiti minimi (ADM) and the impact of AIN transfer to a specific fascicular location on the ulnar-motor nerve.
A retrospective review of one fellowship-trained surgeon's consecutive patients at a single center from December 2019 to September 2021 was conducted. Patients who had an AIN to ulnar-motor nerve transfer for any indication were included and were excluded if they had less than 9 months follow-up.
Seventeen patients were included (88% male, mean age 55 ± 14 years). At early follow-up, compound muscle action potential amplitudes for ADM and FDI did not increase. Compound muscle action potential amplitude for ADM significantly increased at late follow-up ( < .01). Average British Medical Research Council (BMRC) strength increased at early follow-up for FDI ( < .05), but not ADM. The proportion of patients with BMRC ≥ 3 increased for FDI ( < .01) and ADM ( < .05) at late follow-up. Volar-ulnar AIN insertion position did not have a clear effect on outcomes.
The SETS AIN to ulnar-motor nerve transfer demonstrates clinical and electrophysiologic evidence of intrinsic muscle recovery and reinnervation, with differing recovery of outcomes. The role of specific fascicular targeting is still unclear and required further examination as does the mechanism behind differing intrinsic recovering.
“增压”端侧（SETS）骨间前神经（AIN）至尺神经运动支移位术用于改善严重尺神经受压或近端轴索损伤病例中固有肌的恢复情况。此前的研究发现该移位术后固有肌恢复情况存在差异。本研究的目的是检查示指背侧固有肌（FDI）和小指展肌（ADM）的恢复模式，以及AIN移位至尺神经运动支特定束支位置的影响。
对2019年12月至2021年9月在单一中心由一名接受过专科培训的外科医生连续治疗的患者进行回顾性研究。纳入因任何适应证接受AIN至尺神经运动支移位术的患者，随访时间不足9个月的患者被排除。
纳入17例患者（88%为男性，平均年龄55±14岁）。在早期随访时，ADM和FDI的复合肌肉动作电位波幅未增加。ADM的复合肌肉动作电位波幅在晚期随访时显著增加（P<0.01）。FDI在早期随访时平均英国医学研究委员会（BMRC）肌力增加（P<0.05），但ADM未增加。晚期随访时，FDI（P<0.01）和ADM（P<0.05）的BMRC≥3级患者比例增加。掌侧尺侧AIN插入位置对结果没有明显影响。
SETS AIN至尺神经运动支移位术显示了固有肌恢复和再支配的临床及电生理证据，结果恢复情况存在差异。特定束支靶向的作用仍不清楚，需要进一步研究，不同固有肌恢复背后的机制也需要进一步研究。
