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首页> 外文期刊>Journal of Brachial Plexus and Peripheral Nerve Injury >Augmentation of partially regenerated nerves by end-to-side side-to-side grafting neurotization: experience based on eight late obstetric brachial plexus cases
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Augmentation of partially regenerated nerves by end-to-side side-to-side grafting neurotization: experience based on eight late obstetric brachial plexus cases

机译：端到端并排移植神经移植增强部分再生神经：基于八例晚期产科臂丛神经病例的经验

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ObjectiveThe effect of end-to-side neurotization of partially regenerated recipient nerves on improving motor power in late obstetric brachial plexus lesions, so-called nerve augmentation, was investigated.MethodsEight cases aged 3 – 7 years were operated upon and followed up for 4 years (C5,6 rupture C7,8T1 avulsion: 5; C5,6,7,8 rupture T1 avulsion:1; C5,6,8T1 rupture C7 avulsion:1; C5,6,7 ruptureC8 T1 compression: one 3 year presentation after former neurotization at 3 months). Grade 1–3 muscles were neurotized. Grade0 muscles were neurotized, if the electromyogram showed scattered motor unit action potentials on voluntary contraction without interference pattern. Donor nerves included: the phrenic, accessory, descending and ascending loops of the ansa cervicalis, 3rd and 4th intercostals and contralateral C7.ResultsSuperior proximal to distal regeneration was observed firstly. Differential regeneration of muscles supplied by the same nerve was observed secondly (superior supraspinatus to infraspinatus regeneration). Differential regeneration of antagonistic muscles was observed thirdly (superior biceps to triceps and pronator teres to supinator recovery). Differential regeneration of fibres within the same muscle was observed fourthly (superior anterior and middle to posterior deltoid regeneration). Differential regeneration of muscles having different preoperative motor powers was noted fifthly; improvement to Grade 3 or more occurred more in Grade2 than in Grade0 or Grade1 muscles. Improvements of cocontractions and of shoulder, forearm and wrist deformities were noted sixthly. The shoulder, elbow and hand scores improved in 4 cases.LimitationsThe sample size is small. Controls are necessary to rule out any natural improvement of the lesion. There is intra- and interobserver variability in testing muscle power and cocontractions.ConclusionNerve augmentation improves cocontractions and muscle power in the biceps, pectoral muscles, supraspinatus, anterior and lateral deltoids, triceps and in Grade2 or more forearm muscles. As it is less expected to improve infraspinatus power, it should be associated with a humeral derotation osteotomy and tendon transfer. Function to non improving Grade 0 or 1 forearm muscles should be restored by muscle transplantation.Level of evidenceLevel IV, prospective case series.
机译：目的研究部分再生受体神经的端到端神经化对晚期产科臂丛神经病变改善运动能力的作用，即所谓的神经增强。方法对3-7岁的8例患者进行了手术，并随访了4年（C5,6破裂C7,8T1撕脱：5; C5,6,7,8破裂T1撕脱：1; C5,6,8T1破裂C7撕脱：1; C5,6,7破裂C8 T1撕脱：一年后3年在3个月时发生神经质化）。 1-3级肌肉被神经化。如果肌电图显示自愿收缩时运动单元动作电位分散而没有干扰模式，则将0级肌肉神经化。供体神经包括：颈颈,、第三，第四肋间和对侧C7的the神经，副神经，下降和上升环。结果首先观察到远端再生的近端。其次，观察到由同一神经提供的肌肉的差异性再生（上棘上至脊柱下肌再生）。第三，观察到拮抗性肌肉的差异再生（上二头肌至三头肌，前突肌至后旋肌恢复）。第四次观察到同一肌肉内纤维的差异性再生（前三角肌和前三角肌至后三角肌再生）。第五，注意到术前动力不同的肌肉的再生差异。 2级肌肉比3级肌肉或1级肌肉更多地改善到3级或更多。第六，改善了共收缩以及肩，前臂和腕部畸形的改善。 4例患者的肩部，肘部和手部评分得到改善。局限性样本量很小。必须采取控制措施以排除病变的任何自然改善。观察者在观察者之间和观察者之间存在差异，以测试肌肉力量和共收缩。由于人们对改善鼻下肌力量的期望不高，因此应与肱骨脱位截骨术和肌腱转移相关。肌肉移植应恢复对前臂0或1级肌肉无改善的功能。证据级别IV级，前瞻性病例系列。

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