Abstract：
BACKGROUND: Transfer of the fascicle carrying the flexor carpi ulnaris (FCU) branch of the ulnar nerve (UN) to the biceps/brachialis muscle branch of the musculocutaneous nerve (Oberlin\'s procedure), is a mainstay technique for elbow flexion restoration in patients with upper brachial plexus injury. Despite its widespread use, there are few studies regarding the anatomic location of the donor fascicle for Oberlin\'s procedure. Our report aims to analyze the anatomical variability of this fascicle within the UN, while obtaining quantifiable, objective data with intraoperative neuromonitoring (IONM) for donor fascicle selection.
METHODS: We performed a retrospective review of patients at our institution who underwent an Oberlin\'s procedure from September 2019 to July 2023. We used IONM for donor fascicle selection (greatest FCU muscle and least intrinsic hand muscle activation). We prospectively obtained demographic and electrophysiological data, as well as anatomical location of donor fascicles and post-surgical morbidities. Surgeon\'s perception of FCU/intrinsic muscle contraction was compared to objective muscle amplitude during IONM.
RESULTS: Eight patients were included, with a mean age of 30.5 years and an injury-to-surgery interval of 4 months. Donor fascicle was located anterior in two cases, posterior in two, radial in two and ulnar in two patients. Correlation between surgeon\'s perception and IONM findings were consistent in six (75%) cases. No long term motor or sensory deficits were registered.
CONCLUSIONS: Fascicle anatomy within the UN at the proximal arm is highly variable. The use of IONM can aid in optimizing donor fascicle selection for Oberlin\'s procedure.
METHODS: We performed a retrospective review of patients at our institution who underwent an Oberlin\'s procedure from September 2019 to July 2023. We used IONM for donor fascicle selection (greatest FCU muscle and least intrinsic hand muscle activation). We prospectively obtained demographic and electrophysiological data, as well as anatomical location of donor fascicles and post-surgical morbidities. Surgeon\'s perception of FCU/intrinsic muscle contraction was compared to objective muscle amplitude during IONM.
RESULTS: Eight patients were included, with a mean age of 30.5 years and an injury-to-surgery interval of 4 months. Donor fascicle was located anterior in two cases, posterior in two, radial in two and ulnar in two patients. Correlation between surgeon\'s perception and IONM findings were consistent in six (75%) cases. No long term motor or sensory deficits were registered.
CONCLUSIONS: Fascicle anatomy within the UN at the proximal arm is highly variable. The use of IONM can aid in optimizing donor fascicle selection for Oberlin\'s procedure.
摘要：
背景：携带尺神经（UN）的尺侧腕屈肌（FCU）分支的神经束转移到肌皮神经的肱二头肌/肱肌分支（Oberlin程序），是臂丛神经上损伤患者肘部屈曲修复的主要技术。尽管它广泛使用，关于Oberlin手术供体分束的解剖位置的研究很少。我们的报告旨在分析联合国内部该分册的解剖学变异性，在获得可量化的同时，术中神经监测（IONM）的客观数据用于供体束选择。
方法：我们对我们机构于2019年9月至2023年7月接受Oberlin手术的患者进行了回顾性研究。我们使用IONM进行供体束选择（最大的FCU肌肉和最少的内在手部肌肉激活）。我们前瞻性地获得了人口统计学和电生理数据，以及供体束的解剖位置和手术后的发病率。在IONM期间，将外科医生对FCU/内在肌肉收缩的感知与客观肌肉振幅进行了比较。
结果：包括8名患者，平均年龄为30.5岁，受伤至手术间隔为4个月。供束位于前两个病例，在两个后面，两名患者为桡骨，两名患者为尺骨。在6例（75%）病例中，外科医生的感知和IONM发现之间的相关性是一致的。没有记录到长期的运动或感觉缺陷。
结论：近端臂的UN内的血管解剖结构是高度可变的。使用IONM可以帮助优化Oberlin程序的供体束选择。
方法：我们对我们机构于2019年9月至2023年7月接受Oberlin手术的患者进行了回顾性研究。我们使用IONM进行供体束选择（最大的FCU肌肉和最少的内在手部肌肉激活）。我们前瞻性地获得了人口统计学和电生理数据，以及供体束的解剖位置和手术后的发病率。在IONM期间，将外科医生对FCU/内在肌肉收缩的感知与客观肌肉振幅进行了比较。
结果：包括8名患者，平均年龄为30.5岁，受伤至手术间隔为4个月。供束位于前两个病例，在两个后面，两名患者为桡骨，两名患者为尺骨。在6例（75%）病例中，外科医生的感知和IONM发现之间的相关性是一致的。没有记录到长期的运动或感觉缺陷。
结论：近端臂的UN内的血管解剖结构是高度可变的。使用IONM可以帮助优化Oberlin程序的供体束选择。
