Tarnawski-Español Guillermo José, Morro-Martí Maria Rosa, Llusá-Pérez Manuel, Fernández-Conejero Isabel, Benítez-Flores Júlia, Ortega-Centol Aritz, Casañas-Sintes Joaquim
Departament d'Anatomia i Embriologia Humana, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.
Servicio de Traumatología y Cirugía Ortopédica, Hospital Fraternidad-Muprespa Habana, Madrid, Spain.
J Hand Surg Glob Online. 2025 Aug 29;7(6):100818. doi: 10.1016/j.jhsg.2025.100818. eCollection 2025 Nov.
This study aimed to evaluate the use of intraoperative nerve conduction studies in radial to axillary nerve transfers using the motor branches to the triceps. We hypothesized that morphological characteristics might not fully express a donor nerve's suitability for transfer and that choosing the donor branch based on nerve action potential (NAP) amplitudes would lead to better functional outcomes.
This retrospective analysis included 17 patients who underwent radial to axillary nerve transfer. The specific triceps motor branch used as donor and the site of neurorrhaphy were chosen based on intraoperative NAP amplitudes independently of morphological criteria, such as size matching or arc of rotation.
We found a moderate correlation between the NAP amplitude of the transferred branch and shoulder abduction strength at the end of the follow-up. The branch to the lateral head of the triceps was the most often selected as a donor. Outcomes were satisfactory in 14 out of 17 patients.
The findings suggest that reinnervation is enhanced when the choice of the donor branch is individualized and based on functional metrics like NAP, instead of anatomical characteristics. The study supports the role of intraoperative nerve monitoring as an objective and predictable method to refine donor branch selection in radial to axillary nerve transfer.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在评估在利用肱三头肌运动支进行桡神经至腋神经转位术中应用术中神经传导研究的情况。我们假设形态学特征可能无法完全体现供体神经转位的适用性，并且基于神经动作电位（NAP）幅度选择供体分支会带来更好的功能结果。
这项回顾性分析纳入了17例行桡神经至腋神经转位术的患者。基于术中NAP幅度独立于形态学标准（如大小匹配或旋转弧度）来选择用作供体的特定肱三头肌运动支和神经缝合部位。
我们发现在随访结束时，转位分支的NAP幅度与肩部外展力量之间存在中度相关性。肱三头肌外侧头的分支最常被选作供体。17例患者中有14例结果令人满意。
研究结果表明，当供体分支的选择基于NAP等功能指标而非解剖特征进行个体化时，神经再支配会得到增强。该研究支持术中神经监测作为一种客观且可预测的方法在桡神经至腋神经转位术中优化供体分支选择的作用。
研究类型/证据水平：治疗性IV级。
