Optimizing donor fascicle selection in Oberlin's procedure: A retrospective review of anatomical variability using intraoperative neuromonitoring

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-04-25 DOI:10.1002/micr.31178

Lucas Marina MD, Elisa Sanz MD, M. Carmen Morillo Balsera PhD, Lara Cristobal MD, PhD, Andres A. Maldonado MD, PhD

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引用次数: 0

Abstract

Background

Transfer of the fascicle carrying the flexor carpi ulnaris (FCU) branch of the ulnar nerve (UN) to the biceps/brachialis muscle branch of the musculocutaneous nerve (Oberlin's procedure), is a mainstay technique for elbow flexion restoration in patients with upper brachial plexus injury. Despite its widespread use, there are few studies regarding the anatomic location of the donor fascicle for Oberlin's procedure. Our report aims to analyze the anatomical variability of this fascicle within the UN, while obtaining quantifiable, objective data with intraoperative neuromonitoring (IONM) for donor fascicle selection.

Methods

We performed a retrospective review of patients at our institution who underwent an Oberlin's procedure from September 2019 to July 2023. We used IONM for donor fascicle selection (greatest FCU muscle and least intrinsic hand muscle activation). We prospectively obtained demographic and electrophysiological data, as well as anatomical location of donor fascicles and post-surgical morbidities. Surgeon's perception of FCU/intrinsic muscle contraction was compared to objective muscle amplitude during IONM.

Results

Eight patients were included, with a mean age of 30.5 years and an injury-to-surgery interval of 4 months. Donor fascicle was located anterior in two cases, posterior in two, radial in two and ulnar in two patients. Correlation between surgeon's perception and IONM findings were consistent in six (75%) cases. No long term motor or sensory deficits were registered.

Conclusions

Fascicle anatomy within the UN at the proximal arm is highly variable. The use of IONM can aid in optimizing donor fascicle selection for Oberlin's procedure.

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优化奥伯林手术中的供体筋膜选择：利用术中神经监测对解剖变异进行回顾性审查

背景将携带尺神经（UN）尺侧屈肌（FCU）分支的筋膜转移到肌皮神经的肱二头肌/肱肌分支（Oberlin 手术），是上臂丛神经损伤患者恢复肘关节屈曲的主要技术。尽管该方法被广泛使用，但有关奥伯林手术供体筋膜解剖位置的研究却很少。我们的报告旨在分析联合国内该筋膜的解剖变异性，同时通过术中神经监测（IONM）获得可量化的客观数据，用于供体筋膜的选择。方法我们对本机构在 2019 年 9 月至 2023 年 7 月期间接受奥伯林手术的患者进行了回顾性审查。我们使用 IONM 进行供体筋膜选择（最大的 FCU 肌肉和最小的手部固有肌肉激活）。我们前瞻性地获取了人口统计学和电生理学数据，以及供体筋膜的解剖位置和术后发病情况。将外科医生对 FCU/内在肌肉收缩的感知与 IONM 期间的客观肌肉振幅进行比较。结果共纳入八名患者，平均年龄为 30.5 岁，受伤到手术的间隔时间为 4 个月。两例患者的供肌筋膜位于前方，两例位于后方，两例位于桡侧，两例位于尺侧。在六例（75%）病例中，外科医生的感觉与 IONM 检查结果之间的相关性是一致的。没有发现长期的运动或感觉障碍。结论联合国臂近端筋膜解剖结构变化很大。使用 IONM 可以帮助优化奥伯林手术的供体筋膜选择。

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

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.