ANATOMICAL STUDY ON CONTRALATERAL C7 ROOT TRANSFER FOR RECOVERY OF FOREARM FLEXOR FUNCTION IN REPAIRING OF BRACHIAL PLEXUS AVULSION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Bin ¹ , LI Haitao ² , ZHANG Jianfeng ¹ , YANG Huanyou ¹ , LIU Wei ¹ , JIANG Wenping ¹ , ZHAO Gang ¹

1The 1st Department of Hand Surgery, Department of Reparative and Reconstructive Surgery, the Second Hospital of Tangshan, Affiliated Orthopaedic Hospital of Hebei Union University, Tangshan Hebei, 063000, P.R.China;;
2Department of Orthopaedics, Handan Central Hospital. Corresponding author: WANG Bin, E-mail: wbladyp3@163.com;

Corresponding author：

Keywords：

C7 nerve root; Brachial plexus avulsion; Forearm flexor; Muscle atrophy; Anatomial study

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Objective To provide the anatomical basis of contralateral C7 root transfer for the recovery of the forearm flexor function. Methods Thirty sides of adult anti-corrosion specimens were used to measure the length from the end of nerves dominating forearm flexor to the anastomotic stoma of contralateral C7 nerve when contralateral C7 nerve transfer was used for repair of brachial plexus lower trunk and medial cord injuries. The muscle and nerve branches were observed. The length of C7 nerve, C7 anterior division, and C7 posterior division was measured. Results The length of C7 nerve, anterior division, and posterior division was (58.8 ± 4.2), (15.4 ± 6.7), and (8.8 ± 4.4) mm, respectively. The lengths from the anastomotic stoma to the points entering muscle were as follow: (369.4 ± 47.3) mm to palmaris longus, (390.5 ± 38.8) mm (median nerve dominate) and (413.6 ± 47.4) mm (anterior interosseous nerve dominate) to the flexor digitorum superficialis, (346.2 ± 22.3) mm (median nerve dominate) and (408.2 ± 23.9) mm (anterior interosseous nerve dominate) to the flexor digitorum profundus of the index and the middle fingers, (344.2 ± 27.2) mm to the flexor digitorum profundus of the little and the ring fingers, (392.5 ± 29.2) mm (median nerve dominate) and (420.5 ± 37.1) mm (anterior interosseous nerve dominate) to the flexor pollicis longus, and (548.7 ± 30.0) mm to the starting point of the deep branch of ulnar nerve. The branches of the anterior interosseous nerve reached to the flexor hallucis longus, the deep flexor of the index and the middle fingers and the pronator quadratus muscle, but its branches reached to the flexor digitorum superficials in 5 specimens (16.7%). The branches of the median nerve reached to the palmaris longus and the flexor digitorum superficial, but its branches reached to the deep flexor of the index and the middle fingers in 10 specimens (33.3%) and to flexor hallucis longus in 6 specimens (20.0%). Conclusion If sural nerve graft is used, the function of the forearm muscles will can not be restored; shortening of humerus and one nerve anastomosis are good for forearm flexor to recover function in clinical.

Citation： WANG Bin,LI Haitao,ZHANG Jianfeng,YANG Huanyou,LIU Wei,JIANG Wenping,ZHAO Gang. ANATOMICAL STUDY ON CONTRALATERAL C7 ROOT TRANSFER FOR RECOVERY OF FOREARM FLEXOR FUNCTION IN REPAIRING OF BRACHIAL PLEXUS AVULSION. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(10): 1223-1226. doi: Copy

1.	王树锋, 栗鹏程, 褚寅, 等. 健侧C7神经移位与患侧下干直接吻合重建屈指功能的初步研究. 中华骨科杂志, 2007, 27(6): 438-441.
2.	Nicolaidis SC, Williams HB. Muscle preservation using animplantable electrical system after nerve injury and repair. Microsurgery, 2001, 21(6): 241-247.
3.	顾玉东. 臂丛神经损伤与疾病的诊治. 2版. 上海: 复旦大学出版社, 2001: 15-23.
4.	乔晓红, 杜光祖, 薛晓峰, 等. 臂丛神经的应用解剖. 解剖学研究, 2010, 32(1): 46-48.
5.	Flores LP. Epidemiological of the traurnatic brachial plexus injuries in adults. Arq Neuropsiquiatr, 2006, 64(1): 88-94.
6.	Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. J Neurosurgery, 1997, 40(6): 1182-1189.
7.	顾玉东. 臂丛神经损伤研究的方向. 中华手外科杂志, 2008, 24(3): 129.
8.	Taber KH, Maravilla K, Chiou-Tan F, et al. Sectional neuroanatomy of the upper limb I: brachial plexus. J Comput Assist Tomog, 2000, 24(6): 983-986.
9.	Songcharoen P, Wongtrakul S, Mahaisavariya B, et al. Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury. J Hand Surg (Am), 2001, 26(6): 1058-1064.
10.	胡韶楠, 徐建光, 顾玉东, 等. 不同部位骨骼肌失神经支配后超微结构变化的实验研究. 中国修复重建外科杂志, 2002, 16(1): 44-47.
11.	Doi K, Muramatsu K, Hattori Y, et al. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results. J Bone Joint Surg (Am), 2000, 82(5): 652-666.
12.	赵吉连, 李明东, 尹占文, 等. 健侧C7移位与下干直接缝合治疗全臂丛神经损伤. 中华手外科杂志, 2008, 24(5): 319-320.
13.	王斌, 刘伟, 郑桓, 等. 健侧C7神经移位时健侧C7神经吻合口至效应器长度的测量. 中华显微外科杂志, 2009, 32(3): 221-222.
14.	向前生, 杨俊涛, 刘冠兰, 等. 健侧C7神经经椎体后通路治疗臂丛神经根性撕脱伤的解剖学研究. 中国修复重建外科杂志, 2012, 26(2): 235-237.
15.	王成琪, 陈中伟, 朱盛修. 实用显微外科学. 北京: 人民军医出版社, 1992: 84.
16.	徐仕琦, 朱盛修, 刘兴春. 运动神经断裂伤后终板改变入其临床意义. 中华骨科杂志, 1993, 13(4): 247-249.
17.	王斌, 李康华, 邵新中, 等. 骨间前神经旋前方肌支移位在高位尺神经损伤中的应用. 中华手外科杂志, 2007, 23(3): 153-154．.
18.	徐建广, 顾玉东, 李继峰, 等. 被动活动对失神经支配骨骼肌萎缩的影响. 中华显微外科杂志, 2003, 26(3): 210-211.
19.	徐建广, 屠永全, 顾玉东, 等. 电刺激对失神经支配骨骼肌萎缩的影响. 中国修复重建外科杂志, 2003, 17(5): 396-399.
20.	杜亚伟, 刘德群, 王斌, 等. 正中神经和尺神经低位端侧吻合修复臂丛神经下干或高位尺神经损伤的解剖学研究. 中国修复重建外科杂志, 2010, 24(3): 332-334.
21.	许娅莉, 邵新中, 王磊, 等. 神经高位端端与低位端侧或侧侧缝合相结合提高神经修复能力的实验研究. 中华手外科杂志, 2007, 23(2): 103-106.
22.	Veltri K, Kwiecien JM, Minet W, et al. Contribution of the distal nerve sheath to nerve and muscle preservation following denervation and sensory protection. J Reconstr Microsurg, 2005, 21(1): 57-70.

1. 王树锋, 栗鹏程, 褚寅, 等. 健侧C7神经移位与患侧下干直接吻合重建屈指功能的初步研究. 中华骨科杂志, 2007, 27(6): 438-441.
2. Nicolaidis SC, Williams HB. Muscle preservation using animplantable electrical system after nerve injury and repair. Microsurgery, 2001, 21(6): 241-247.
3. 顾玉东. 臂丛神经损伤与疾病的诊治. 2版. 上海: 复旦大学出版社, 2001: 15-23.
4. 乔晓红, 杜光祖, 薛晓峰, 等. 臂丛神经的应用解剖. 解剖学研究, 2010, 32(1): 46-48.
5. Flores LP. Epidemiological of the traurnatic brachial plexus injuries in adults. Arq Neuropsiquiatr, 2006, 64(1): 88-94.
6. Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. J Neurosurgery, 1997, 40(6): 1182-1189.
7. 顾玉东. 臂丛神经损伤研究的方向. 中华手外科杂志, 2008, 24(3): 129.
8. Taber KH, Maravilla K, Chiou-Tan F, et al. Sectional neuroanatomy of the upper limb I: brachial plexus. J Comput Assist Tomog, 2000, 24(6): 983-986.
9. Songcharoen P, Wongtrakul S, Mahaisavariya B, et al. Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury. J Hand Surg (Am), 2001, 26(6): 1058-1064.
10. 胡韶楠, 徐建光, 顾玉东, 等. 不同部位骨骼肌失神经支配后超微结构变化的实验研究. 中国修复重建外科杂志, 2002, 16(1): 44-47.
11. Doi K, Muramatsu K, Hattori Y, et al. Restoration of prehension with the double free muscle technique following complete avulsion of the brachial plexus. Indications and long-term results. J Bone Joint Surg (Am), 2000, 82(5): 652-666.
12. 赵吉连, 李明东, 尹占文, 等. 健侧C7移位与下干直接缝合治疗全臂丛神经损伤. 中华手外科杂志, 2008, 24(5): 319-320.
13. 王斌, 刘伟, 郑桓, 等. 健侧C7神经移位时健侧C7神经吻合口至效应器长度的测量. 中华显微外科杂志, 2009, 32(3): 221-222.
14. 向前生, 杨俊涛, 刘冠兰, 等. 健侧C7神经经椎体后通路治疗臂丛神经根性撕脱伤的解剖学研究. 中国修复重建外科杂志, 2012, 26(2): 235-237.
15. 王成琪, 陈中伟, 朱盛修. 实用显微外科学. 北京: 人民军医出版社, 1992: 84.
16. 徐仕琦, 朱盛修, 刘兴春. 运动神经断裂伤后终板改变入其临床意义. 中华骨科杂志, 1993, 13(4): 247-249.
17. 王斌, 李康华, 邵新中, 等. 骨间前神经旋前方肌支移位在高位尺神经损伤中的应用. 中华手外科杂志, 2007, 23(3): 153-154．.
18. 徐建广, 顾玉东, 李继峰, 等. 被动活动对失神经支配骨骼肌萎缩的影响. 中华显微外科杂志, 2003, 26(3): 210-211.
19. 徐建广, 屠永全, 顾玉东, 等. 电刺激对失神经支配骨骼肌萎缩的影响. 中国修复重建外科杂志, 2003, 17(5): 396-399.
20. 杜亚伟, 刘德群, 王斌, 等. 正中神经和尺神经低位端侧吻合修复臂丛神经下干或高位尺神经损伤的解剖学研究. 中国修复重建外科杂志, 2010, 24(3): 332-334.
21. 许娅莉, 邵新中, 王磊, 等. 神经高位端端与低位端侧或侧侧缝合相结合提高神经修复能力的实验研究. 中华手外科杂志, 2007, 23(2): 103-106.
22. Veltri K, Kwiecien JM, Minet W, et al. Contribution of the distal nerve sheath to nerve and muscle preservation following denervation and sensory protection. J Reconstr Microsurg, 2005, 21(1): 57-70.

Chinese Journal of Reparative and Reconstructive Surgery

ANATOMICAL STUDY ON CONTRALATERAL C7 ROOT TRANSFER FOR RECOVERY OF FOREARM FLEXOR FUNCTION IN REPAIRING OF BRACHIAL PLEXUS AVULSION

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