Malungpaishrope Kanchai, Kittithamvongs Piyabuth, Tie Joyce
Institute of Orthopaedics, Lerdsin General Hospital, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand.
College of Medicine, Rangsit University, Lak Hok, Thailand.
J Hand Surg Asian Pac Vol. 2025 Aug;30(4):399-407. doi: 10.1142/S2424835525500596. Epub 2025 Jul 22.
Primary neuroma excision and autografting are the gold-standard surgical treatments for brachial plexus birth injury (BPBI). With the rising popularity of distal nerve transfers, it is more frequently utilised to manage BPBI. However, distal transfers for BPBI remain under investigation. We reviewed the updated evidence for nerve transfers compared to nerve grafting as a primary approach for shoulder and elbow reconstruction in Narakas I and II neonatal brachial plexus palsy. A systematic review of the literature was performed according to the PRISMA guidelines. PubMed and Cochrane Central Register of Controlled Trials were searched using the search terms: ([{brachial plexus} AND {neonatal OR obstetric}] AND [graft OR grafting]) AND (transfer OR transfers). Most studies did not specify the indications for grafting versus nerve transfer. Some suggested indications for nerve transfer surgery in BPBI include late presentations and nerve root avulsions. There was significantly greater improvement in shoulder external rotation postoperatively in the nerve transfer group compared to the nerve grafting group. There was no significant difference between the nerve transfer and nerve grafting groups for shoulder flexion, abduction and total active movement scale score. Patients undergoing nerve grafting were more likely to undergo a secondary shoulder stabilising procedure, though this was not statistically significant. The current literature shows that there appears to be little difference in functional outcomes between nerve grafting and nerve transfers. Level III (Therapeutic).
原发性神经瘤切除和自体移植是臂丛神经产伤（BPBI）的金标准外科治疗方法。随着远端神经移位术越来越受欢迎，它也更频繁地用于治疗BPBI。然而，BPBI的远端移位术仍在研究中。我们回顾了与神经移植相比，神经移位作为纳拉卡斯I型和II型新生儿臂丛神经麻痹肩肘重建主要方法的最新证据。根据PRISMA指南对文献进行了系统综述。使用搜索词在PubMed和Cochrane对照试验中央登记库中进行搜索：（[{臂丛神经} AND {新生儿或产科}] AND [移植或移植术]）AND（移位或移位术）。大多数研究没有明确移植与神经移位的指征。一些研究表明，BPBI中神经移位手术的指征包括就诊较晚和神经根撕脱。与神经移植组相比，神经移位组术后肩外旋改善明显更大。神经移位组和神经移植组在肩屈曲、外展和总主动运动量表评分方面没有显著差异。接受神经移植的患者更有可能接受二次肩部稳定手术，尽管这在统计学上没有显著意义。当前文献表明，神经移植和神经移位在功能结局上似乎没有太大差异。III级（治疗性）。
