Direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy in the treatment of brachial plexus injury
Direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy in the treatment of brachial plexus injury
复制标题
DOI：
10.3171/jns.2007.106.3.391
复制
发表时间：
2007-03-01
影响因子：
4.1
通讯作者：
Dubovy, Petr
中科院分区：
文献类型：
--
作者：
Haninec, Pavel;Samal, Filip;Dubovy, Petr
目的。作者介绍了他们的臂丛神经损伤患者组中神经移植和神经化手术的长期结果，并将“经典”神经修复方法与端侧神经缝合术的结果进行了比较。方法。 1994年至2006年间，对168名患者进行了直接修复（神经移植）、神经固定和端侧神经缝合术，其中95名患者术后随访至少2年。直接修复后的成功率为 79%，端到端神经化后的成功率为 56%。神经化的结果取决于所使用的供体神经的类型。在接受腋神经和肌皮神经神经化的患者中，使用丛内神经（臂丛神经的运动分支）作为运动纤维的供体与使用丛外神经相比，成功率显着更高（分别为 81% 和 49%，p = 0.003）。由于使用丛外神经进行腋神经神经化术的功能效果不佳（成功率47.4%），作者对14例不完全撕脱患者采用端侧神经缝合术。使用腋神经作为受者的端侧神经缝合术的成功率为 64.3%，与使用丛内神经的神经化成功率 (68.4%) 相似，并且优于使用丛外神经的神经化成功率 (47.4%，p = 0.19)。结论。端侧神经缝合术比传统的神经固定术具有不需要牺牲任何周围神经或尺神经束的优点。在端侧神经缝合术后的患者中观察到受受体神经支配的肌肉收缩与供体神经支配的肌肉收缩的典型联动。
Object. The authors present the long-term results of nerve grafting and neurotization procedures in their group of patients with brachial plexus injuries and compare the results of "classic" methods of nerve repair with those of end-to-side neurorrhaphy.Methods. Between 1994 and 2006, direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy were performed in 168 patients, 95 of whom were followed up for at least 2 years after surgery. Successful results were achieved in 79% of cases after direct repair and in 56% of cases after end-to-end neurotization. The results of neurotization depended on the type of the donor nerve used. In patients who underwent neurotization of the axillary and the musculocutaneous nerves, the use of intraplexal nerves (motor branches of the brachial plexus) as donors of motor fibers was associated with a significantly higher success rate than the use of extraplexal nerves (81% compared with 49%, respectively, p = 0.003). Because of poor functional results of axillary nerve neurotization using extraplexal nerves (success rate 47.4%), the authors used end-to-side neurorrhaphy in 14 cases of incomplete avulsion. The success rate for end-to-side neurorrhaphy using the axillary nerve as a recipient was 64.3%, similar to that for neurotization using intraplexal nerves (68.4%) and better than that achieved using extraplexal nerves (47.4%, p = 0.19).Conclusions. End-to-side neurorrhaphy offers an advantage over classic neurotization in not requiring sacrifice of any of the surrounding nerves or the fascicles of the ulnar nerve. Typical synkinesis of muscle contraction innervated by the recipient nerve with contraction of muscles innervated by the donor was observed in patients after end-to-side neurorrhaphy.