Contralateral C7 Nerve Transfer with Direct Coaptation to Restore Lower Trunk Function After Traumatic Brachial Plexus Avulsion

被引:70
|
作者
Wang, Shu-feng [1 ]
Li, Peng-cheng [1 ]
Xue, Yun-hao [1 ]
Yiu, Hon-wah [1 ]
Li, Yu-Cheng [1 ]
Wang, Hai-hua [1 ]
机构
[1] Beijing Jishuitan Hosp, Dept Hand Surg, Beijing 100035, Peoples R China
来源
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME | 2013年 / 95A卷 / 09期
关键词
ROOT AVULSION; MEDIAN NERVE; INJURIES; TRANSECTION;
D O I
10.2106/JBJS.L.00039
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Contralateral C7 nerve transfer to the median nerve has been used in an attempt to restore finger flexion in patients with total brachial plexus avulsion injury. However, the results have not been satisfactory mainly because of the requirement to use a long bridging nerve graft, which causes an extended nerve regeneration process and irreversible muscle atrophy. A new procedure involving contralateral C7 nerve transfer via a modified prespinal route and direct coaptation with the injured lower trunk is presented here. Methods: Contralateral C7 nerve transfer via the modified prespinal route and direct coaptation with the injured lower trunk was performed in seventy-five patients with total brachial plexus avulsion injury. Thirty-five required humeral shortening osteotomy (3 to 4.5 cm) in order to accomplish the direct coaptation. The contralateral C7 nerve was also transferred to the musculocutaneous nerve through the bridging medial antebrachial cutaneous nerve arising from the lower trunk in forty-seven of the seventy-five patients. Recovery of finger, wrist, and elbow flexion was evaluated with use of the modified British Medical Research Council muscle grading system. Results: The mean follow-up period (and standard deviation) was 57 +/- 6 months (range, forty-eight to seventy-eight months). Motor function with a grade of M3+ or greater was attained in 60% of the patients for elbow flexion, 64% of the patients for finger flexion, 53% of the patients for thumb flexion, and 72% of the patients for wrist flexion. Conclusions: Contralateral C7 nerve transfer via a modified prespinal route and direct coaptation with the injured lower trunk decreases the distance for nerve regeneration in patients with total brachial plexus avulsion injury. There was satisfactory recovery of finger flexion and wrist flexion in this series. In addition, contralateral C7 nerve transfer was successfully used to repair two different target nerves: the lower trunk and the musculocutaneous nerve.
引用
收藏
页码:821 / 827
页数:7
相关论文
共 50 条
  • [1] Contralateral C7 Transfer for Treatment of Brachial Plexus Root Avulsion
    Hu, S.
    Gu, Y.
    HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE, 2014, 46 (02) : 80 - 84
  • [2] Total brachial plexus injury: contralateral C7 root transfer to the lower trunk versus the median nerve
    Jiang, Ye
    Wang, Li
    Lao, Jie
    Zhang, Xin
    NEURAL REGENERATION RESEARCH, 2018, 13 (11) : 1968 - 1973
  • [3] Retropharyngeal Contralateral C7 Nerve Transfer to the Lower Trunk for Brachial Plexus Birth Injury: Technique and Results
    Vu, Anthony T.
    Sparkman, Darlene M.
    van Belle, Christopher J.
    Yakuboff, Kevin P.
    Schwentker, Ann R.
    JOURNAL OF HAND SURGERY-AMERICAN VOLUME, 2018, 43 (05): : 417 - 424
  • [4] Total brachial plexus injury: contralateral C7 root transfer to the lower trunk versus the median nerve
    Ye Jiang
    Li Wang
    Jie Lao
    Xin Zhao
    Neural Regeneration Research, 2018, 13 (11) : 1968 - 1973
  • [6] The prespinal route in contralateral C7 nerve root transfer for brachial plexus avulsion injuries
    McGuiness, CN
    Kay, SPJ
    JOURNAL OF HAND SURGERY-BRITISH AND EUROPEAN VOLUME, 2002, 27B (02): : 159 - 160
  • [7] Effect of Ipsilateral C7 Nerve Root Transfer on Restoration of Rat Upper Trunk Muscle and Nerve Function After Brachial Plexus Root Avulsion
    Song, Jie
    Chen, Liang
    Gu, Yudong
    ORTHOPEDICS, 2010, 33 (12)
  • [8] Transdiscal C6–C7 contralateral C7 nerve root transfer in the surgical repair of brachial plexus avulsion injuries
    Vicente Vanaclocha
    Juan Manuel Herrera
    Francisco Verdu-Lopez
    Laurabel Gozalbes
    Moises Sanchez-Pardo
    Marlon Rivera
    Deborah Martinez-Gomez
    Juan D. Mayorga
    Acta Neurochirurgica, 2015, 157 : 2161 - 2167
  • [9] Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury
    Songcharoen, P
    Wongtrakul, S
    Mahaisavariya, B
    Spinner, RJ
    JOURNAL OF HAND SURGERY-AMERICAN VOLUME, 2001, 26A (06): : 1058 - 1064
  • [10] Contralateral C7 nerve root transfer to neurotize the upper trunk via a modified prespinal route in repair of brachial plexus avulsion injury
    Wang, Shufeng
    Yiu, Hon-Wan
    Li, Pengcheng
    Li, Yucheng
    Wang, Haihua
    Pan, Yongwei
    MICROSURGERY, 2012, 32 (03) : 183 - 188