Genedy Mohamed K A, Salama Esraa Y, Elsaadany Mohamed Ashraf, AbdelWahab Mohamed A F, Amin Ahmed Fathy, Lashin Ahmed A, Sabry Ahmed O
Faculty of Medicine, Cairo University, Cairo, Egypt.
Faculty of Medicine, Benha University, Benha, Egypt.
Acta Neurochir (Wien). 2025 Aug 26;167(1):229. doi: 10.1007/s00701-025-06650-0.
Nerve transfers are a cornerstone in the surgical management of traumatic brachial plexus injuries (BPIs) to restore elbow flexion. Common donor nerves include intraplexal sources like the ulnar and median nerves (fascicular transfers) and extraplexal sources like the intercostal nerves (ICNs). Despite the widespread use of both techniques, the optimal donor nerve remains a subject of debate. This systematic review and meta-analysis aims to compare these techniques for restoring elbow flexion in BPIs.
A systematic search was conducted across PubMed, Embase, Cochrane Library, Scopus, and Web of Science to identify comparative studies. The quality of the studies included was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analyses were performed to compare motor recovery (≥ M3), time to M3 recovery, and complication rates between the two surgical approaches.
The analysis included 13 studies with a total of 537 patients. In the overall cohort, which included mixed injury patterns, fascicular transfers showed a statistically significant advantage for achieving ≥ M3 recovery (RR = 0.84, 95% CI [0.75, 0.94]). However, when the analysis was restricted to patients with only upper-BPIs, there was no significant difference in achieving ≥ M3 strength between fascicular and ICN transfers (RR = 0.92, 95% CI [0.82, 1.04]). Fascicular transfers resulted in a significantly faster time to ≥ M3 recovery by approximately five months (MD = 5.25, 95% CI [2.87, 7.62]). Donor-site morbidity (18 sensory, 10 motor deficits) and wrist co-flexion were reported in fascicular transfer groups, whereas pneumothorax (4 cases) was the primary complication for ICN transfers.
In patients with upper-BPIs, fascicular and ICN transfers yield comparable elbow flexion strength. The choice of procedure is a trade-off between the faster recovery offered by fascicular transfers and the better rehabilitation course of ICN transfers.
神经移位术是创伤性臂丛神经损伤（BPI）手术治疗中恢复肘关节屈曲功能的基石。常见的供体神经包括臂丛内的尺神经和正中神经等（束状移位）以及臂丛外的肋间神经（ICN）等。尽管这两种技术都被广泛应用，但最佳的供体神经仍是一个有争议的问题。本系统评价和荟萃分析旨在比较这些技术在恢复BPI患者肘关节屈曲功能方面的效果。
在PubMed、Embase、Cochrane图书馆、Scopus和科学网进行系统检索，以确定比较研究。使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。进行荟萃分析以比较两种手术方法之间的运动恢复情况（≥M3）、达到M3恢复的时间以及并发症发生率。
分析纳入了13项研究，共537例患者。在包括混合损伤模式的总体队列中，束状移位在实现≥M3恢复方面显示出统计学上的显著优势（RR = 0.84，95% CI [0.75, 0.94]）。然而，当分析仅限于仅患有上干型BPI的患者时，束状移位和ICN移位在达到≥M3肌力方面没有显著差异（RR = 0.92，95% CI [0.82, 1.04]）。束状移位导致达到≥M3恢复的时间明显快约五个月（MD = 5.25，95% CI [2.87, 7.62]）。束状移位组报告了供体部位的并发症（18例感觉、10例运动功能障碍）和腕关节协同屈曲，而气胸（4例）是ICN移位的主要并发症。
在上干型BPI患者中，束状移位和ICN移位产生的肘关节屈曲力量相当。手术方法的选择是在束状移位提供的更快恢复和ICN移位更好的康复过程之间进行权衡。
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