Artikel
Selektive Nerven Transfers und deren Effekt auf die Neonatale Motorische Einheit
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Veröffentlicht: | 10. Oktober 2017 |
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Objectives: Despite advances in obstetric monitoring and techniques, the incidence rate of obstetric brachial plexus lesions (OBPL) has remained constant over the last decades. Although recovery occurs in the majority of cases, satisfying long-term rehabilitation cannot always be achieved. Hence, research on the reconstruction of OBPL and techniques to bridge proximal nerve defects remain urgent. Selective nerve transfers (SNT) promise to be a powerful tool, but the neurophysiological effects on peripheral nervous system and the motor unit have not been adequately investigated. Furthermore, the tremendous capacity of nerve regeneration and plasticity of the central nervous system in the neonate cannot be compared to studies available in the adult. Therefore, we specifically designed an experimental nerve transfer model in the forelimb of the neonatal rat.
Method: A randomized controlled trial was designed. In the experimental group, 15 male Sprague-Dawley neonates, the ulnar nerve was transferred to the musculocutaneous nerve. A standardized crush of the musculocutaneous nerve was performed in another 15 rats. In a negative control group (n=5), the musculocutaneous nerve was dissected and an 8 mm nerve defect was created and five further rats underwent sham surgery. The burden of surgery to the pups and the recovery process were continuously evaluated. After 12 weeks of nerve regeneration neurophysiological effects were explicitly assessed.
Results: By applying the newly developed protocol dam cannibalizing and pup rejection were reduced and overall survival reached a satisfying level of over 88%. The nerve transfer successfully reinnervated the musculocutaneous nerve in all animals, as indicated by functional outcome, muscle force and motoneuron count. Compared against the crush-group equivalent regeneration was found. No aberrant reinnervation occurred from the original motor source in the negative control group. The selective nerve transfer was followed by a massive fibre type switch.
Conclusion: Applying this neonate model will help to attain a deeper understanding of the neurophysiologic effects of SNT on new-borns. As selective nerve transfers play a major role in extremity reconstruction findings of such studies further help improving clinical approaches. Additionally, neonatal plasticity can be investigated in the peripheral nerve system. Ultimately, these advances might also be used to further understand neuronal regeneration and improve treatment options in the reconstruction of OBPL.