Abstract: Investigation into the Optimal Number of Intercostal Nerve Transfers for Musculocutaneous Nerve Re-Innervation
Notice bibliographique
Résumé
INTRODUCTION: Intercostal nerve transfer is one approach to neurotize the musculocutaneous nerve in brachial plexus injury. This study investigates outcomes following intercostal nerve transfer with a primary focus on the number of nerve transfers required to achieve optimal return of elbow flexion. MATERIALS AND METHODS: A systematic review of the literature was performed in accordance with PRISMA guidelines searching the MEDLINE/Pubmed and Google Scholar databases. Studies investigating intercostal nerve transfer for musculocutaneous innervation following brachial plexus injury in adults were included.1–5 Citations were cross-referenced and relevant studies included for analysis. All studies evaluated return of motor function based on the British Medical Research Council scale for muscle strength. Statistics were calculated using weighted means and the student’s t test with α ≤ 0.05. With β = 20%, power calculations demonstrated a minimum of 25 patients per study arm. RESULTS: Nine studies were included for analysis. A total of 641 patients were analyzed with average age 24.9 ± 5.4 years and 93% male population. The average time to surgery was 4.0 ± 1.5 months with average follow up of 41.3 ± 3.7 months. One study reported a single intercostal transfer resulting in restoration of M3 strength elbow flexion. Eight studies reported transfer of 2 intercostals in 414 patients with 76.6% of patients achieving ≥M3 flexion. Six studies reported transfer of 3 intercostals in 218 patients with 62.4% of patients achieving ≥M3 flexion. Finally, 6 (87.5%) of the 8 patients who underwent 4 intercostal nerve transfers achieved ≥M3 flexion. There was no statistically significant difference in return of ≥M3 function between 2 vs. 3 transfers (p = 0.4), 2 vs. 4 transfers (p = 0.4), and 3 vs. 4 transfers (p = 0.07). When comparing return of M4 vs. M3 function, more patients developed M4 function when transferring 2 intercostal nerves (p = 0.05), but there was no difference when transferring 3 intercostals (p = 0.2). CONCLUSION: Intercostal nerve transfer to the musculocutaneous nerve is an operation largely performed in 25-year-old males around 4 months after brachial plexus injury. No significant difference in return of ≥M3 elbow flexion was demonstrated with increased transfer of intercostal nerves. Based on equivalent outcomes, transfer of 2 intercostal nerves is recommended. DISCLOSURE/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Merrell GA, Barrie KA, Katz DL, Wolfe SW. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am. 2001;26(2):303–14. 2. Nagano A. Intercostal nerve transfer for elbow flexion. Tech Hand Up Extrem Surg. 2001;5(3):136–40. 3. Xiao C, Lao J, Wang T, Zhao X, Liu J, Gu Y. Intercostal nerve transfer to neurotize the musculocutaneous nerve after traumatic brachial plexus avulsion: a comparison of two, three, and four nerve transfers. J Reconstr Microsurg. 2014;30(5):297–304. 4. Coulet B, Boretto JG, Lazerges C, Chammas M. A comparison of intercostal and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5-C6+/-C7). J Hand Surg Am. 2010;35(8):1297–303. 5. Songcharoen P. Brachial plexus injury in Thailand: a report of 520 cases. Microsurgery. 1995;16(1):35–9
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».