Contralateral C7 transfer via both ulnar nerve and medial antebrachial cutaneous nerve to repair total brachial plexus avulsion: a preliminary report

Aim: After brachial plexus injuries, sacrifice of the contralateral C7 (cC7) root from the non-injured side is well tolerated and various schemes to innervate the injured side from the cC7 root have been used. Objective: To demonstrate the surgical outcomes from transferring the cC7 to the affected side via both the ulnar nerve and medial antebrachial cutaneous nerve (MACN). Methods: A retrospective study of 16 adult patients sustaining total brachial plexus avulsion who underwent this procedure. The British Medical Research Council (MRC) grading system and the disabilities of the arm, shoulder, and hand (DASH) questionnaire scoring were used to evaluate the recovery. Results: About 68.75% of the patients achieved functional recovery of elbow flexion to M3 or better and 43.75% achieved motor recovery of wrist and finger flexion to M3 or better. Sensation in the median nerve territory recovered to S2 or better in 68.75%. The DASH scores after surgery were significantly lower than those before surgery. Conclusions: cC7 transfer via both ulnar and MACNs is an effective and safe procedure in patients sustaining total injuries of brachial plexus.

研究背景与目的：臂丛神经损伤后，牺牲取自健侧的对侧C7（contralateral C7, cC7）神经根的手术耐受良好，且已有多种通过cC7神经根为患侧肢体提供神经支配的手术方案得到应用。
研究目标：验证通过尺神经与前臂内侧皮神经（medial antebrachial cutaneous nerve, MACN）两条通路将cC7移位至患侧的手术疗效。
研究方法：本研究为回顾性研究，纳入16例接受该手术的完全性臂丛根性撕脱伤成年患者。采用英国医学研究理事会（British Medical Research Council, MRC）肌力分级系统与上肢、肩、手功能障碍（disabilities of the arm, shoulder, and hand, DASH）问卷评分对患者的功能恢复情况进行评估。
研究结果：约68.75%的患者肘关节屈曲功能恢复至M3级及以上，43.75%的患者腕关节与手指屈曲运动功能恢复至M3级及以上。68.75%的患者正中神经支配区感觉功能恢复至S2级及以上。术后DASH评分显著低于术前评分。
研究结论：通过尺神经与前臂内侧皮神经通路进行cC7移位术治疗完全性臂丛神经损伤患者，是一种安全有效的手术方式。