Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study
Contralateral cervical seventh nerve transfer for spastic arm paralysis via a modified prespinal route: a cadaveric study
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DOI：
10.1007/s00701-019-04069-y
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发表时间：
2020-01-01
影响因子：
2.4
通讯作者：
Xu, Wendong
中科院分区：
文献类型：
--
作者：
Li, PeiYang;Shen, Yundong;Xu, Wendong
我们于2018年在新英格兰医学杂志（NEJM）上提出了对侧颈第七神经转移治疗中枢神经损伤后的痉挛性手臂瘫痪。在这次手术中，我们采用了一种新的神经移位手术路线，华山前路线。本研究的目的是阐述我们的新手术技术，阐明其与椎动脉的关系，并提供这种新方法的解剖学数据。方法从解剖学角度评价华山椎前入路移位健侧C7神经的有效性和安全性。9具尸体（4只雄性，5只雌性）可用于本研究。其中6具尸体的椎动脉解剖学参数和3具尸体的对侧C7神经经华山椎前路移位的双侧颈7神经吻合情况进行了观察。结果经华山椎前入路完成双侧颈七神经的无张力吻合。椎动脉与矢状面（以甲状软骨为起点）的倾斜角为25.5 ± 4.5度，左侧和右侧分别为22.5 ± 1.6度和28.7 ± 4.3度。在我们的手术技术中，穿透颈长肌以创建颈长肌隧道以避免损伤椎动脉的安全钻孔角度大于33.2度。结论尸体实验证实，该技术是一种简单、有效、安全的健侧C7神经移位术。该技术可用于偏瘫和臂丛神经损伤的治疗。对于该手术路线，有一个安全的钻孔角度范围来创建颈长肌隧道。本研究所获得的解剖学参数将有助于该手术的实施。
Background We proposed contralateral cervical seventh nerve transfer for spastic arm paralysis after central neurological injury in the New England Journal of Medicine (NEJM) in 2018. In this surgery, we applied a new surgical route for nerve transfer, the Huashan prespinal route. The objective of this study was to elaborate our new surgical technique, clarify its relationship to the vertebral artery, and provide anatomical data on this novel method. Methods The effectiveness and safety of the Huashan prespinal route in contralateral C7 nerve transfer were evaluated anatomically. Nine cadavers (4 males, 5 females) were available for this study. Among these, anatomical parameters of the vertebral artery were obtained from 6 cadavers, and the anastomosis of the bilateral cervical seventh nerve was observed on 3 cadavers undergoing contralateral C7 nerve transfer via the Huashan prespinal route. Results Tension-free anastomosis of the bilateral cervical seventh nerve was achieved through the Huashan prespinal route. The tilt angle of the vertebral artery to the sagittal plane (with thyroid cartilage as the origin) was 25.5 +/- 4.5 degrees, at 22.5 +/- 1.6 degrees and 28.7 +/- 4.3 degrees on the left and right side, respectively. The safe drilling angle to penetrate through the longus colli muscles for the creation of a longus colli muscle tunnel to avoid injury to the vertebral artery in our surgical technique was above 33.2 degrees. Conclusions The cadaveric study confirms that the presented technique allowed simple, effective, and safe contralateral C7 nerve transfer. This technique can be used in the treatment of hemiplegia and brachial plexus injury. There is a safe scope of drilling angle for creating the longus colli muscle tunnel required for this surgical route. The anatomical parameters obtained in this study will be helpful for the performance of this operation.