Grisdela Phillip T, Ostergaard Peter J, Watkins Colyn J, Bauer Andrea S
Boston Children's Hospital, Department of Orthopedics, Harvard Medical School, Boston, MA.
Northwestern Memorial Hospital, Department of Orthopaedic Surgery, Feinberg School of Medicine, Chicago, IL.
J Pediatr Soc North Am. 2024 Feb 12;5(1):605. doi: 10.55275/JPOSNA-2023-605. eCollection 2023 Feb.
The utilization of nerve transfer procedures in the upper extremity following brachial plexus injury, trauma, spinal cord injury, tumors, infection, or other etiologies are well established. Nerve injuries in the lower extremity pose several additional challenges, including longer distance to target motor end plates, delayed presentation, and concomitant limb trauma. Nerve transfers in the lower extremity have the potential to provide functional (sensory or motor) recovery distally after direct surgical coaptation of a functional donor nerve to a non-functional recipient nerve. The ability to perform pure motor or sensory fascicular transfers allows for focused recovery while limiting donor morbidity. Indications for nerve transfers in the lower extremity are evolving, but transfers have been utilized for non-recovering peroneal, obturator, femoral, or tibial nerve palsies, to provide protective sensation to the plantar aspect of the foot as well as for painful neuropathies/neuromas. There is a paucity of orthopaedic literature on this topic and our review aims to highlight the current state of lower extremity nerve transfers as they relate to the practicing orthopaedist, including future directions in the field.
•Nerve transfers have been well-established as a treatment option for nerve injuries of the upper extremity and brachial plexus, but their use in the lower extremities is less common.•Nerve transfers may be of particular interest in the lower extremity because of the ability to cover relatively long distances as well as avoid the zone of injury, especially in far proximal injuries.•Nerve transfers of the lower extremity have been used to address motor deficit of the peroneal, femoral, obturator, and tibial nerves, as well as tibial and sural nerve sensory loss.•There is currently a paucity of orthopaedic literature on lower extremity nerve transfers and further understanding is required to better utilize these techniques to manage lower extremity peripheral nerve injury.
在臂丛神经损伤、创伤、脊髓损伤、肿瘤、感染或其他病因后，上肢神经移位手术的应用已得到充分确立。下肢神经损伤带来了一些额外的挑战，包括到达目标运动终板的距离更长、就诊延迟以及合并肢体创伤。下肢神经移位有可能在将功能性供体神经直接与无功能的受体神经进行手术吻合后，使远端实现功能（感觉或运动）恢复。进行纯运动或感觉束状移位的能力可实现有针对性的恢复，同时限制供体的发病率。下肢神经移位的适应症在不断发展，但已被用于治疗无法恢复的腓总神经、闭孔神经、股神经或胫神经麻痹，为足底提供保护性感觉以及治疗疼痛性神经病变/神经瘤。关于这个主题的骨科文献很少，我们的综述旨在突出下肢神经移位的现状，以及它们与骨科医生的相关性，包括该领域的未来发展方向。
•神经移位作为上肢和臂丛神经损伤的治疗选择已得到充分确立，但在下肢的应用较少见。•由于能够覆盖相对较长的距离以及避开损伤区域，特别是在近端损伤较远的情况下，神经移位在下肢可能特别有意义。•下肢神经移位已被用于解决腓总神经、股神经、闭孔神经和胫神经的运动功能障碍，以及胫神经和腓肠神经的感觉丧失。•目前关于下肢神经移位的骨科文献很少，需要进一步了解以便更好地利用这些技术来处理下肢周围神经损伤。
