Zusammenfassung
Wenn in einem Skelettmuskel als Folge eines traumatischen Defektes oder einer Tumoroperation die Region um die Eintrittsstelle des motorischen Nervs verlorengeht, so kann zur funktionellen Rekonstruktion in Ermangelung eines distalen Nervenstumpfes keine konventionelle Nerventransplantation durchgeführt werden. Wir empfehlen für diese Fälle die Rekonstruktion durch direkte Einpflanzung des Spendernervs in den Muskel. Wir beschreiben ein standardisiertes chirurgisches Verfahren, welches bei 19 Patienten zur Anwendung kam und zu einer motorischen Regeneration vom Kraftgrad M4 führte. Das wesentliche Element dieser Technik besteht in der interfaszikulären Dissektion der Nerventransplantate und einer möglichst weiträumigen Verteilung der Nerventransplantate in dem Muskelgewebe.
Abstract
Loss of muscle tissue at the area of the neuromuscular junction after tumor resection or after trauma precludes the reconstruction with conventional nerve grafts, because the distal nerve stump is absent. For these cases, we recommend direct insertion of the nerve grafts into the muscle. We describe a standardized technique, which has been performed in 19 patients and led to a mean motor recovery of grade M4 after Highet. The key procedure of this technique is the interfascicular dissection of the nerve grafts, which allows a wide distribution of the grafts into the muscle tissue.
Schlüsselwörter
Muskuläre Neurotisation - Nervenregeneration - muskuläre Regeneration - motorische Endplatten - neuromuskuläre Verbindung
Key words
Muscular neurotisation - nerve regeneration - muscular regeneration - motor endplates - neuromuscular junction
Literatur
-
1
Aitken J T.
Growth of nerve implants in voluntary muscle.
J Anat.
1950;
84
38-49
-
2
Becker M, Lassner F, Fansa H, Mawrin C, Pallua N.
Refinements in nerve to muscle neurotisation.
Muscle Nerve.
2002;
26
36-41
-
3
Brunelli G, Monini L.
Direct muscular neurotisation.
J Hand Surg [Am].
1985;
10
993-997
-
4 Brunelli G A, Brunelli G R. Direct muscle neurotization. Omer GE, Spinner M, van Beek AL Management of Peripheral Nerve Problems. Philadelphia; Saunders 1998: 393-397
-
5
Brunelli G A, Brunelli G R.
Direct muscle neurotization.
J Reconstr Microsurg.
1993;
9
81-90
-
6
Erlacher P.
Direct and muscular neurotization of paralyzed muscles.
Am J Orthop Surg.
1915;
13
22-32
-
7
Guth L, Zalewski A A.
Disposition of cholinesterase following implantation of nerve into innervated and denervated muscle.
Exp Neurol.
1963;
7
316-326
-
8
Gutmann E, Young J Z.
The Re-innervation of muscle after various periods of atrophy.
J Anat.
1944;
78
15
-
9
Heineke H.
Die direkte Einpflanzung der Nerven in den Muskel.
Zentralbl Chir.
1914;
41
465-466
-
10
Highet W B, Holmes W.
Traction injuries to the lateral popliteal nerves and traction injuries to peripheral nerves after suture.
Br J Surg.
1943;
30
212
-
11
Korneliussen H, Sommerschild H.
Ultrastructure of the new neuromuscular junctions formed during reinnervation of rat soleus muscle by a “foreign” nerve.
Cell Tissue Res.
1976;
167
439-452
-
12
Mackinnon S E, McLean J A, Hunter G A.
Direct muscle neurotization recovers gastrocnemius muscle function.
J Reconstr Microsurg.
1993;
9
77-80
-
13
McNamara M J, Garrett W E, Seaber A V, Goldner J L.
Neurorraphy, nerve grafting and neurotization: a functional comparison of nerve reconstruction techniques.
J Hand Surg [Am].
1987;
12
354-360
-
14
Meals R A, Nelissen R G.
The origin and meaning of “neurotization”.
J Hand Surg [Am].
1995;
20
144-146
-
15
Millesi H.
Peripheral nerve repair: terminology, questions, and facts.
J Reconstr Microsurg.
1985;
2
21-31
-
16 Millesi H. Brachial plexus injuries: Management and results. Terzis JK Microreconstruction of Nerve Injuries. Philadelphia; Saunders 1987: 355-358
-
17
Park D M, Shon S K, Kim Y J.
Direct muscle neurotization in rat soleus muscle.
J Reconstr Microsurg.
2000;
16
135-140
-
18
Payne S H, Brushart T M.
Neurotization of the rat soleus muscle: a quantitative analysis of reinnervation.
J Hand Surg [Am].
1997;
22
640-643
-
19
Saito A, Zacks S I.
Fine structure of neuromuscular junction after nerve section and implantation of nerve in denervated muscle.
Exp Mol Pathol.
1969;
10
256
-
20
Sakellarides H, Sorbie C, James L.
Reinnervation of denervated muscles by nerve transplantation.
Clin Orthop.
1972;
83
194-201
-
21
Sorbie C, Porter T L.
Reinnervation of paralyzed muscles by direct motor nerve implantation.
J Bone Joint Surg [Br].
1969;
51
156-164
-
22
Steindler A.
The method of direct neurotization of paralyzed muscles.
Am J Orthop Surg.
1915;
13
33-45
-
23
Steindler A.
Direct neurotization of paralyzed muscles. Further studies of the question of direct implantation.
Am J Orthop Surg.
1916;
14
707-719
-
24
Zhang F, Lineaweaver C, Ustuner T, Kao S D, Tonken H P, Campagna-Pinto D, Buncke H J.
Comparison of muscle mass preservation in denervated muscle and transplanted muscle flaps after motor and sensory reinnervation and neurotization.
Plast Reconstr Surg.
1997;
99
803-814
PD Dr. med. Franz Lassner
Klinik für Plastische, Hand- und Wiederherstellungschirurgie · Universitätsklinikum Aachen
Pauwelsstraße 30
52074 Aachen
Email: flassner@ukaachen.de
