Applied Anatomy Of The Intercostal Nerve And Its Application In Functional Reconstruction Of The Limb After Brachial Plexus Injury

Part ?:Applied Anatomy of Intercostal NerveOBJECTIVETo explore the applied anatomical characteristics of intercostal nerves and the feasibility of intercostal nerve displacement to reconstruct the function of the affected limb after brachial plexus injury,and provide corresponding anatomical basis.Materials and MethodFour frozen fresh adult cadaver specimens and 4 sides,and 20 adult cadaver specimens fixed with neutral formaldehyde and 20 sides were selected to dissect and separate the shape and distribution characteristics of intercostal nerves.From the midaxillary line to the midline of the clavicle,the intercostal nerves were completely free.Anatomical measurements were made with a ruler(accuracy 1mm),tape measure(accuracy 1mm)and vernier caliper(accuracy 0.01mm).The intercostal nerves were taken at the level of the midclavicular line,the midline of the clavicle and the anterior axillary line,the level of the anterior axillary line,and the level of the axillary line respectively.Paraffin-embedded sections were stained with hematoxylin-yin red and toluidine blue..The number of myelinated nerve fibers and the cross-sectional area of nerve bundles in different planes of each intercostal nerve were measured.Compare the anatomical length of each nerve above with the length required for transplantation,and use IBM SPSS Statistics 23.0 to perform paired t test for analysis.ResultsThe intercostal nerve is constant from the anterior branch of the thoracic nerve and runs on the lower edge of the rib cage.If the intercostal nerves of the third,fourth,and fifth intercostal nerves are cut open at the midline of the clavicle and separated to the midaxillary line,the anatomical length of the intercostal nerves and the corresponding intercostal axillary The difference between the length of the subcutaneous tunnel from the midline to the four sides of the hole is(3.74±0.50)cm,(3.44±1.08)cm,(2.54 ± 1.25)cm,and the remaining length is longer,which can be different from the axillary nerve,median nerve,musculocutaneous nerve,radial The nerve is sutured without tension at the four sides of the hole.The difference between the anatomical length of the sixth intercostal nerve and the length of the subcutaneous tunnel is(0.30±1.30)cm.The available length is short.It can be sutured with the median nerve,musculocutaneous nerve,and radial nerve at the foramen without tension,but It is difficult to sew directly with the axillary nerve.It is necessary to continue to dissect the axillary line to increase the length of the intercostal nerve,which may increase the damage to the donor area.The difference between the anatomical length of the intercostal nerve and the length of the subcutaneous tunnel is(-2.09±1.54cm),and it is difficult to directly sew the axillary nerve,median nerve,musculocutaneous nerve,and radial nerve at the four-sided foramen.The number of the intercostal nerves of the third,fourth,fifth,sixth and seventh intercostal nerves at the midline of the clavicle is(413.25 ± 78.12)roots,(506.25 ± 74.87)roots,(453.25±59.67)roots,(560.00 ± 50.29)roots,(686.25 ±32.17)roots,the number of midline horizontal nerve fibers connecting the anterior axillary line and the clavicle midline are(464.75 ± 116.31)roots,(520.00 ± 82.63)roots,(588.75±93.82)roots,(655.50±90.15))Roots,(869.75 ± 49.45)roots.The number of nerve fibers on the anterior axillary line were(540.75 ± 68.64)roots,(557.50 ± 64.46)roots,(645.75±49.59)roots,(749.25±68.93)roots,(906.00 ±69.67)roots;at the level of the axillary line The number of nerve fibers is(704.00±100.47)roots,(870.00 ± 65.20)roots,(1055.25± 88.98)roots,(1246.00 ± 54.94)roots,(1491.25 ± 116.26)roots.ConclusionThe intercostal nerves of the third,fourth,and fifth intercostal nerves can usually be anastomoticly anastomosed to the target nerve,and only some specimens(25.0%,12.5%)of the intercostal nerves of the sixth and seventh intercostal nerves can be anastomotic to the target nerve.The remaining specimens(75.0%,87.5%)cannot be directly sutured with the intercostal nerve,and need to be dissected freely to the posterior axillary line to obtain more available length.Compared with target nerves such as musculocutaneous nerve and median nerve,the intercostal nerve fiber content is relatively small.Usually,multiple intercostal nerves need to be braided into cables and then sutured with the target nerve.Part ?:Observation of clinical effect of intercostal nerve displacement to reconstruct brachial plexus nerve injuryOBJECTIVEObserve the effect of brachial plexus injury in patients with brachial plexus injury.Materials and Method22 patients with total brachial plexus injury,more than 3 months after the injury and have been confirmed by the exploration of the supraclavicular brachial plexus nerves,including 20 cases of root avulsion injury of the whole brachial plexus,severe root avulsion injury of the upper and middle trunk of the brachial plexus In 2 cases,the intercostal nerve displacement was used to reconstruct brachial plexus nerve injury after injury to surgery for 3 to 11 months,including 9 cases of intercostal nerve displacement to reconstruct musculocutaneous nerve,8 cases of radial nerve reconstruction,and axillary nerve reconstruction.In 2 cases,1 case was reconstructed simultaneously with musculocutaneous nerve and radial nerve,and 1 case was reconstructed in each of the posterior and medial bundles of the brachial plexus.The postoperative follow-up period was 18 to 60 months,and the patients'upper extremity function was evaluated according to the British Medical Research Council(MRC)classification system.Results17 of 22 patients(77.27%)had good or excellent intercostal nerve excision and displacement.Among them,displacement was the best for repairing musculocutaneous nerve,followed by posterior bundle,axillary nerve,and medial bundle,and displacement was used to repair radial nerve.Function recovery is poor.ConclusionIntercostal nerve displacement reconstructs shoulder and elbow joints after brachial plexus injury.The excellent rate(postoperative muscle strength recovery?M3)is about 77.27%,which can effectively restore the shoulder and elbow function of the affected limb.