Direct Repair of Ruptured Nerve Stump to Middle Trunk for Restoration of Extrinsic Finger Extension in Total Brachial Plexus Injuries.

IF 3.2 2区医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2024-11-01 Epub Date: 2024-01-23 DOI:10.1097/PRS.0000000000011306

Yunhao Xue, Shufeng Wang, Jingjing Hu, Wenjun Li, Feng Li, Bhatia Anil, Pengcheng Li, Yaobin Yin, Fangfang Duan, Qipei Wei

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Abstract

Background: Attempts to restore independent hand function in total brachial plexus injuries (TBPIs) have often failed due to inconsistent results of finger extension reconstruction. An innovative technique is described to achieve this effect by direct neurorrhaphy of residual (ruptured) roots with the middle trunk.

Methods: Direct coaptation of the ruptured roots to the middle trunk and, simultaneously, transferring the anterior division of the middle trunk to the posterior division of the lower trunk was performed in 64 patients with TBPI. The return of extension of the elbow, wrist, and fingers was monitored.

Results: Excellent and good muscle strength of finger extension were noted in 45.3% of cases. The patients were divided into group A (>32 years) and group B (≤32 years) according to receiver operating characteristic curve analysis. The difference of excellent and good rates of finger and wrist extension muscle strengths between the 2 groups was statistically significant (χ 2 = 4.635, P = 0.031; χ 2 = 6.615, P = 0.010).

Conclusions: Direct neurorrhaphy of ruptured nerve root stumps with the middle trunk could achieve satisfactory results for finger extension in TBPI for patients ≤32 years old. Long nerve defects (4 to 6.5 cm) could be overcome by freeing the nerve and adducting the arm against the trunk.

Clinical question/level of evidence: Risk, III.

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直接修复中干断裂的神经残端，以恢复臂丛神经完全损伤患者的手指外展功能。

背景：由于手指伸展重建的结果不一致，试图恢复全臂丛神经损伤（TBPI）患者独立手部功能的努力往往以失败告终。本文介绍了一种创新技术，通过将残留（断裂）的神经根与中干直接神经吻合来实现这一目标：方法：对 64 名 TBPI 患者实施了将断裂的指根与中干直接接合，同时将中干前部转移至下干后部的手术。对肘部、腕部和手指的伸展恢复情况进行了监测：结果：45.3%的患者手指伸展肌力良好。根据 ROC 曲线分析将患者分为 A 组（大于 32 岁）和 B 组（小于 32 岁）。两组患者伸指和伸腕肌力的优、良率差异有统计学意义（χ 2=4.635，P=0.031 χ 2=6.615，P=0.010）：对于年龄小于 32 岁的患者，用中干对断裂的神经根残端进行直接神经切断术可在 TBPI 中获得满意的手指伸展效果。长神经缺损（4-6.5 厘米）可通过游离神经并将手臂向躯干内收来克服。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.