Acta Neurochirurgica ( IF 2.4 ) Pub Date : 2020-06-06 , DOI: 10.1007/s00701-020-04433-3 Marcio de Mendonça Cardoso 1 , Ricardo Gepp 1 , Flávio Leão Lima 2 , Andreia Gushiken 3
Background
To recover biceps strength in patients with complete brachial plexus injuries, the intercostal nerve can be transferred to the musculocutaneous nerve. The surgical results are very controversial, and most of the studies with good outcomes and large samples were carried out in Asiatic countries. The objective of the study was to evaluate biceps strength after intercostal nerve transfer in patients undergoing this procedure in a Western country hospital.
Methods
We retrospectively analyzed 39 patients from 2011 to 2016 with traumatic brachial plexus injuries receiving intercostal to musculocutaneous nerve transfer in a rehabilitation hospital. The biceps strength was graded using the British Medical Research Council (BMRC) scale. The variables reported and analyzed were age, the time between trauma and surgery, surgeon experience, body mass index, nerve receptor (biceps motor branch or musculocutaneous nerve), and the number of intercostal nerves transferred. Statistical tests, with a significance level of 5%, were used.
Results
Biceps strength recovery was graded ≥M3 in 19 patients (48.8%) and M4 in 15 patients (38.5%). There was no statistical association between biceps strength and the variables. The most frequent complication was a pleural rupture.
Conclusions
Intercostal to musculocutaneous nerve transfer is a safe procedure. Still, biceps strength after surgery was ≥M3 in only 48.8% of the patients. Other donor nerve options should be considered, e.g., the phrenic or spinal accessory nerves.
中文翻译:
完全外伤性臂丛神经损伤患者的肋间至肌皮神经转移:病例系列。
背景
为了恢复完全臂丛神经损伤患者的二头肌力量,可以将肋间神经转移到肌皮神经。外科手术的结果是有争议的,大多数具有良好结果和大量样本的研究都是在亚洲国家进行的。这项研究的目的是评估西方乡村医院中接受该手术的患者肋间神经转移后的二头肌强度。
方法
我们回顾性分析了2011年至2016年间39例在康复医院接受创伤性臂丛神经损伤,接受肋间至肌皮神经转移的患者。二头肌强度使用英国医学研究理事会(BMRC)量表进行分级。报告和分析的变量包括年龄,外伤和手术之间的时间,外科医生的经验,体重指数,神经受体(二头肌运动支或肌皮神经)和转移的肋间神经数量。统计检验的显着性水平为5%。
结果
二头肌力量恢复分级≥M3 19例(48.8%),M4 15例(38.5%)。二头肌力量与变量之间没有统计关联。最常见的并发症是胸膜破裂。
结论
肋间肌向肌皮神经的转移是一种安全的方法。尽管如此,仅48.8%的患者术后二头肌强度≥M3。应该考虑其他供体神经选择,例如the神经或脊柱副神经。