Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis

被引：0
作者：
Michal Makeľ
Andrej Sukop
David Kachlík
Petr Waldauf
Adam Whitley
Radek Kaiser
机构：
[1] Charles University and University Hospital Královské Vinohrady,Department of Plastic Surgery, Third Faculty of Medicine
[2] Charles University,Department of Anatomy, First Faculty of Medicine
[3] Charles University,Department of Anatomy, Second Faculty of Medicine
[4] Charles University and University Hospital Královské Vinohrady,Department of Anaesthesia and Intensive Care Medicine, Third Faculty of Medicine
[5] Charles University and University Hospital Královské Vinohrady,Department of General Surgery, Third Faculty of Medicine
[6] Charles University and Military University Hospital Prague,Department of Neurosurgery and Neurooncology, First Faculty of Medicine
来源：
Neurosurgical Review | 2022年 / 45卷
关键词：
Brachial plexus injury; Axillary nerve; Suprascapular nerve; Neurotization; Shoulder abduction;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66 ± 1.02 vs intercostal nerves 3.48 ± 0.64, p = 0.086). However, the difference in ROM was statistically significant (radial nerve 106.33 ± 39.01 vs. intercostal nerve 80.42 ± 24.9, p < 0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.
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页码：1303 / 1312
页数：9
相关论文
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