{"title":"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。","authors":"Yunhao Xue, Shufeng Wang, Jingjing Hu, Wenjun Li, Feng Li, Bhatia Anil, Pengcheng Li, Yaobin Yin, Fangfang Duan, Qipei Wei","doi":"10.1097/PRS.0000000000011306","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>","PeriodicalId":20128,"journal":{"name":"Plastic and reconstructive surgery","volume":" ","pages":"939e-948e"},"PeriodicalIF":3.2000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Direct Repair of Ruptured Nerve Stump to Middle Trunk for Restoration of Extrinsic Finger Extension in Total Brachial Plexus Injuries.\",\"authors\":\"Yunhao Xue, Shufeng Wang, Jingjing Hu, Wenjun Li, Feng Li, Bhatia Anil, Pengcheng Li, Yaobin Yin, Fangfang Duan, Qipei Wei\",\"doi\":\"10.1097/PRS.0000000000011306\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical question/level of evidence: </strong>Risk, III.</p>\",\"PeriodicalId\":20128,\"journal\":{\"name\":\"Plastic and reconstructive surgery\",\"volume\":\" \",\"pages\":\"939e-948e\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Plastic and reconstructive surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PRS.0000000000011306\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Plastic and reconstructive surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PRS.0000000000011306","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Direct Repair of Ruptured Nerve Stump to Middle Trunk for Restoration of Extrinsic Finger Extension in Total Brachial Plexus Injuries.
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.
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.
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