目的:神经转移通常用于治疗臂丛神经完全损伤,但是供体神经是有限的,并且优先针对肘部屈曲和肩部外展的恢复。这项研究的目的是表征在臂丛手术中识别提上肩cap肌(LSN)神经的解剖参数,为了评估将该分支转移到肩胛骨上神经(SSN)或胸外侧神经(LPN)的可行性,并展示一系列手术结果。
方法:对20具新鲜的人类尸体进行臂丛神经上和锁骨下暴露,以测量不同的解剖参数来鉴定LSN。接下来,对将该分支转移到SSN和LPN的可行性进行了解剖学和组织形态学评估。最后,通过量化10例患者的手臂内收强度评估了LSN-LPN转移的有效性.
结果:在95%的尸体标本中发现了LSN。LSN和SSN的直接接合在45%的标本(n=9)中是可能的,但在任何标本中LSN和LPN之间都不可能。三种神经之间轴突计数的比较未显示任何显着差异。在经历LSN到LPN转移的患者中,有70%(n=7)观察到主要胸肌神经支配的良好结果(医学研究理事会等级≥3)。
结论:通过锁骨上入路对臂丛神经进行一致识别,它的转移提供SSN和LPN的功能在解剖学上是可行的。在大多数患者中观察到LSN-LPN转移的良好结果。即使需要使用长神经移植物。
Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this
study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series.
Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength.
The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade ≥ 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer.
The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.