中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (12): 2132-2140.doi: 10.4103/1673-5374.262600

• 原著:周围神经损伤修复保护与再生 • 上一篇    下一篇

对侧C7移植到臂丛神经上干和人脱细胞异体神经移植修复肩肘功能恢复的比较

  

  • 出版日期:2019-12-15 发布日期:2019-12-15
  • 基金资助:

    国家自然科学基金资助项目(81572130，81601057); 中国国家重点研究发展计划(2016YFC1101603);广东省自然科学基金(2015A030310350)

Comparison between direct repair and human acellular nerve allografting during contralateral C7 transfer to the upper trunk for restoration of shoulder abduction and elbow flexion

Liang Li , Wen-Ting He , Ben-Gang Qin, Xiao-Lin Liu, Jian-Tao Yang , Li-Qiang Gu   

  1. Department of Orthopedic Trauma and Microsurgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
  • Online:2019-12-15 Published:2019-12-15
  • Contact: Li-Qiang Gu, MD, PhD, guliqiang1963@aliyun.com; Jian-Tao Yang, MD, PhD, truth123811@163.com.
  • Supported by:

    This work was supported by the National Natural Science Foundation of China, No. 81572130 (to LQG) and 81601057 (to JTY); the National Key Research and Development Plan of China, No. 2016YFC1101603 (to XLL); and the Natural Science Foundation of Guangdong Province of China, No. 2015A030310350 (to JTY).

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摘要：

健侧颈7(contralateral cervical 7, CC7)与臂丛神经上干直接缝合可避免神经移植物的使用。前期的研究成功缩短了CC7与臂丛神经上干间的距离及移植物的长度，部分选择性病例能达到直接缝合，但部分病例仍然需要神经移植物桥接，自体神经移植是周围神经移植的金标准，但也存在诸多的供区并发症。人类去细胞同种异体神经移植物(human acellular nerve allografts, hANAs)的临床应用有效避免了自体神经移植并发症的发生。试验旨在探讨健侧颈7转位直接修复臂丛神经上干和应用人类去细胞同种异体神经移植物桥接修复臂丛损伤后肩外展和肘关节屈曲的临床效果。共有51例臂丛损伤患者纳入此回顾性研究，根据修复方式的不同将患者分为2组：27例进行了健侧颈7与臂丛神经上干直接修复；24例进行健侧颈7与臂丛神经上干间利用人去细胞同种异体神经(hANAs组)桥接修复。术中测量截取的健侧颈7神经根长度，术后根据英国医学研究委员会的评分系统评定患肢三角肌和肱二头肌的肌力以及肩外展和肘关节屈曲的角度，并将有意义的肌力恢复定义为M3-M5级。(1)术中测量的直接修复组健侧颈7神经根至前后股长度分别为(7.64±0.69) mm和(7.55±0.69) mm，hANAs组为(6.46±0.58) mm和(6.43±0.59) mm；(2)超过4年的术后随访结果显示，直接修复组三角肌和肱二头肌有意义的肌力恢复率分别为88.89％和85.19％，hANAs组中为70.83％和66.67％；(3)直接修复组中C5/C6神经再支配的时间短于hANAs组；(4)上述观察数据证实，健侧颈7转位直接修复臂丛神经上干有助于恢复肩外展和肘关节屈曲功能，如果不能缝合，使用人去细胞同种异体神经移植物也是合适的修复方法。试验于2017-11-14经中国中山大学附属第一医院伦理委员会批准，伦理批准号：[2017] 290。

orcid: 0000-0003-0532-5093(Li-Qiang Gu)
          0000-0002-8530-6740(Jian-Tao Yang)

关键词: 健侧颈7转位, 神经移物, 臂丛撕脱伤, 直接缝合, 人类去细胞同种异体神经移植物, 肩关节功能, 肘关节功能, 神经转位, 膈神经, 副神经

Abstract:

Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system; meaningful recovery was defined as M3–M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID: [2017] 290) on November 14, 2017.

Key words: nerve regeneration, contralateral C7 nerve root transfer, nerve graft, brachial plexus avulsion injury, direct repair, human acellular nerve allograft, shoulder function, elbow function, nerve transfer, phrenic nerve, accessary nerve, neural regeneration