Functional outcome of contralateral C7 nerve transfer combined with free functional gracilis transplantation to repair total brachial plexus avulsion: a report of thirty-nine cases.
Functional outcome of contralateral C7 nerve transfer combined with free functional gracilis transplantation to repair total brachial plexus avulsion: a report of thirty-nine cases.
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对侧C7神经移植联合游离功能性股薄肌移植修复臂丛神经撕脱伤39例功能疗效分析
DOI：
10.1007/s00264-021-05108-z
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发表时间：
2022-05
影响因子：
2.7
通讯作者：
Gu L
中科院分区：
文献类型：
--
作者：
Chen J;Qin B;Wang H;Fang J;Yang J;Gu L
全臂丛神经撕脱伤的治疗是临床上的一个挑战，尤其是手功能的恢复。目前主要的手术顺序是从近端到远端关节。本研究的目的是证明“远端到近端”手术方法的结果。39例患者一期行对侧C7（CC 7）神经移位直接修复下干（CC 7-LT）和膈神经移位至肩胛上神经（PN-SSN），然后行功能性股薄肌游离移植（FFGT）屈肘、伸指。采用改良的英国医学研究理事会（mBMRC）评分系统进行上肢肌力、肩外展度、肘关节屈曲度、Semmes-Weinstein单丝试验和静态两点辨别力测试。结果显示，66.7%的肩外展患者、87.2%的肘屈曲患者、48.7%的手指伸展患者和25.6%的手指屈曲患者的运动恢复达到M3 +或更高水平。平均肩关节外展角为45.5°（0-90°），平均肘关节屈曲角为107.2°（0-142°），平均屈曲强度为2.5 kg（0.5-5 kg）。此外，71.8%的患者达到了保护敏感性（≥ S2）。CC 7移植联合游离功能性股薄肌移植是重建TBPA的有效方法。它可以帮助患者恢复肩关节的稳定性和屈肘、伸指功能，更重要的是提供手指感觉和部分手指屈曲功能。但是，拾取功能不满意，需要额外手术。
Treatment of total brachial plexus avulsion (TBPA) is a challenge in the clinic, especially the restoration of hand function. The current main surgical order is from proximal to distal joints. The purpose of this study was to demonstrate the outcomes of “distal to proximal” surgical method. Thirty-nine patients underwent contralateral C7 (CC7) nerve transfer to directly repair the lower trunk (CC7-LT) and phrenic nerve transfer to the suprascapular nerve (PN-SSN) during the first stage, followed by free functional gracilis transplantation (FFGT) for elbow flexion and finger extension. Muscle strength of upper limb, degree of shoulder abduction and elbow flexion, and Semmes–Weinstein monofilament test and static two-point discrimination of the hand were examined according to the modified British Medical Research Council (mBMRC) scoring system. The results showed that motor recovery reached a level of M3 + or greater in 66.7% of patients for shoulder abduction, 87.2% of patients for elbow flexion, 48.7% of patients for finger extension, and 25.6% of patients for finger flexion. The mean shoulder abduction angle was 45.5° (range 0–90°), and the average elbow flexion angle was 107.2° (range 0–142°), with 2.5 kg average flexion strength (range 0.5–5 kg). In addition, protective sensibility (≥ S2) was found to be achieved in 71.8% of patients. In reconstruction of TBPA, CC7 transfer combined with free functional gracilis transplantation is an available treatment method. It could help patients regain shoulder joint stability and the function of elbow flexion and finger extension and, more importantly, provide finger sensation and partial finger flexion function. However, the pick-up function was unsatisfied, which needed additional surgery.
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影响因子：
1.1
作者：
Boe, Chelsea C.;Elhassan, Bassem T.
通讯作者：
Elhassan, Bassem T.
影响因子：
1.8
作者：
Doi, K.
通讯作者：
Doi, K.
影响因子：
4.8
作者：
Feng, Juntao;Wang, Tao;Zhu, Yi
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影响因子：
3.6
作者：
Maldonado, Andres A.;Kircher, Michelle F.;Shin, Alexander Y.
通讯作者：
Shin, Alexander Y.
影响因子：
2.3
作者：
Coulet, B.;El Ouali, M. Id;Chammas, M.
通讯作者：
Chammas, M.