Jeffs Alexander D, Fisher Margaret M, Wellborn Patricia K, Allen Andrew D, Lauck Bradley J, Baumann Charles A, Luther G Aman
The University of North Carolina, Department of Orthopaedics, 130 Mason Farm Road, Chapel Hill, NC, 27514, United States of America.
The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC, 27599, United States of America.
J Orthop. 2025 Mar 15;70:20-24. doi: 10.1016/j.jor.2025.03.034. eCollection 2025 Dec.
Radial sensory nerve (RSN) injuries occur during common surgical procedures or injuries to the wrist and often result in the formation of painful neuromas. Management strategies of primary repair or secondary reconstruction are limited by poor patient satisfaction. We present a targeted muscle reinnervation (TMR) technique, its clinical outcomes, and a novel classification system for the treatment of recalcitrant RSN neuromas with transfer of the RSN to the anterior interosseous nerve (AIN).
Cadaveric specimens were used to devise a classification system for the transfer. RSN to AIN transfer was performed after simulated injury at three levels: proximal, at, and distal to the bifurcation. The transfer was performed in five patients with symptomatic recalcitrant RSN neuromas. Clinical and patient-reported outcomes were prospectively collected for one year.
A cadaveric classification system was devised to guide nerve transfer. Five patients underwent RSN to AIN transfer for symptomatic recalcitrant RSN neuromas. There was one Zone 1 injury, two Zone 2 injuries, and three Zone 3 injuries. The mean visual analog scale (VAS) pain score significantly improved by 6 ± 2 points. The mean Quick Disabilities of Arm, Shoulder, & Hand (DASH) scores significantly improved by 37 ± 11 points (p < 0.05). The wrist flexion/extension arc significantly improved by 30 ± 14°, and the radial/ulnar deviation arc significantly improved by 10 ± 3° (p < 0.05).
Our classification system can guide intraoperative decision-making for RSN to AIN transfer based on the zone of RSN injury. RSN to AIN transfer resulted in significant improvement in QuickDASH and VAS Pain scores that exceeded the established thresholds for substantial clinical benefit.
桡侧感觉神经（RSN）损伤常见于普通外科手术或手腕受伤时，常导致疼痛性神经瘤形成。一期修复或二期重建的治疗策略因患者满意度低而受限。我们介绍一种靶向肌肉神经再支配（TMR）技术、其临床疗效以及一种新的分类系统，用于治疗难治性RSN神经瘤，即将RSN转移至骨间前神经（AIN）。
使用尸体标本设计转移的分类系统。在模拟损伤后的三个水平（近端、分叉处、远端）进行RSN至AIN转移。对5例有症状的难治性RSN神经瘤患者进行了转移手术。前瞻性收集临床和患者报告的疗效数据，为期一年。
设计了一种尸体分类系统以指导神经转移。5例有症状的难治性RSN神经瘤患者接受了RSN至AIN转移。有1例1区损伤、2例2区损伤和3例3区损伤。视觉模拟量表（VAS）疼痛评分平均显著改善6±2分。手臂、肩部和手部快速残疾（DASH）评分平均显著改善37±11分（p<0.05）。腕关节屈伸弧度平均显著改善30±14°，桡尺偏斜弧度平均显著改善10±3°（p<0.05）。
我们的分类系统可根据RSN损伤区域指导RSN至AIN转移的术中决策。RSN至AIN转移使QuickDASH和VAS疼痛评分显著改善，超过了既定的显著临床获益阈值。
