Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up
Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up
复制标题
人脱细胞同种异体神经移植联合对侧 C7 神经根移植恢复臂丛神经损伤肩外展和肘屈曲的分析：平均 4 年随访。
DOI：
10.3171/2019.2.jns182620
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发表时间：
2020-06-01
影响因子：
4.1
通讯作者：
Gu, Liqiang
中科院分区：
文献类型：
--
作者：
Li, Liang;Yang, Jiantao;Gu, Liqiang
目的：人类脱细胞神经异体移植在临床实践中的应用越来越多，但没有研究量化其对高阶、大阶和混合神经，特别是臂丛神经重建结果的影响。作者研究了对侧C7 （CC7）神经根移植用于臂丛损伤（BPI）患者神经间隙重建的功能结果，并确定了肩外展和肘关节屈曲恢复的独立预测因素。方法45例部分或全部BPI患者采用同种异体脱细胞神经移植CC7神经根至上肢后进行回顾性研究。根据改进的英国医学研究委员会（mBMRC）评分系统检查三角肌和二头肌肌力、肩外展度和肘关节屈曲度、semes - weinstein单丝试验和静态两点辨别（S2PD），并对手臂、肩膀和手的残疾（DASH）进行评分，以确定受累上肢的功能。有意义的恢复定义为基于评分系统的M3-M5或S3-S4等级。通过亚组分析、单因素和多因素logistic回归分析确定人类脱细胞神经异体移植重建的预测因素。结果平均随访时间为48.1±10.1个月，同种异体脱细胞神经移植长度为30.9±5.9 mm。71.1%和60.0%的患者三角肌和二头肌肌力为M4级或M3级。年龄< 20岁、年龄20 ~ 29岁的患者在三角肌和二头肌力量方面有意义的恢复率较高，DASH评分较低（p < 0.01）；同种异体移植物长度≤30mm；损伤至手术时间间隔< 90天的患者。Semmes-Weinstein单丝试验和S2PD中有意义的感觉恢复率约为70%。根据单因素和多因素logistic回归分析，年龄、损伤与手术间隔时间和同种异体移植物长度显著影响功能预后。结论同种异体脱细胞神经移植修复BPI术后上干CC7神经根移植可安全重建20 ~ 50mm神经间隙。同种异体移植物长度≤30 mm组比其他组获得更好的功能预后，该手术中推荐的同种异体移植物长度小于30 mm。年龄、损伤与手术间隔时间和同种异体神经移植长度是人类脱细胞神经移植重建后功能结局的独立预测因素。
OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3-M5 or S3-S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20-29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.