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28.05.2018 | Original Article - Peripheral Nerves | Ausgabe 7/2018

Acta Neurochirurgica 7/2018

Transfer of obturator nerve for femoral nerve injury: an experiment study in rats

Zeitschrift:
Acta Neurochirurgica > Ausgabe 7/2018
Autoren:
Depeng Meng, Jun Zhou, Yaofa Lin, Zheng Xie, Huihao Chen, Ronghua Yu, Haodong Lin, Chunlin Hou
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-018-3565-1) contains supplementary material, which is available to authorized users.
Depeng Meng and Jun Zhou contributed equally to this work.

Comments

For the past 40 years, nerve transfers have been used to restore function following injuries to the upper brachial plexus. At the present time, these transfers have a very high success rate. What I find most interesting is that through plasticity, the brain adapts to the new wiring circuit following the nerve transfer to effortlessly restore function.
While there are a few reports in the literature, nerve transfers have not been as frequently employed for injuries in the lower extremities. The authors explore the feasibility of transferring the proximal obturator nerve to the distal femoral nerve in rats. While the author’s measurements of success are indirect, they are compelling. This transfer could be employed under very specific circumstances in humans. As the femoral and obturator nerves run so close together in the pelvis, it would be an unusual injury that produced an injury to the femoral nerve that could not be repaired using nerve grafts but left the obturator nerve intact.
I was impressed by the fact that the three branches of the rat obturator nerve the authors anastomosed to the femoral nerve seemed to cover the cut surface of the femoral nerve. In humans, the obturator nerve is much smaller than the femoral nerve. Once the obturator nerve leaves the pelvis, there are two distinct branches which take relatively disparate courses and would need to be dissected for a distance in order to obtain enough length to transpose to the femoral nerve. It should be noted that in humans, the important motor branches to the quadriceps coming off the femoral nerve are already segregated to the posterior aspect of the nerve. Thus, if a surgeon were to attempt this anastomosis, I would recommend that the smaller obturator branches be attached to the posterior aspect of the femoral stump.
I congratulate the authors on a well-performed laboratory experiment.
Allan Friedman
North Carolina, USA

Abstract

Background

Quadriceps palsy is mainly caused by proximal lesions in the femoral nerve. The obturator nerve has been previously used to repair the femoral nerve, although only a few reports have described the procedure, and the outcomes have varied. In the present study, we aimed to confirm the feasibility and effectiveness of this treatment in a rodent model using the randomized control method.

Methods

Sixty Sprague–Dawley rats were randomized into two groups: the experimental group, wherein rats underwent femoral neurectomy and obturator nerve transfer to the femoral nerve motor branch; and the control group, wherein rats underwent femoral neurectomy without nerve transfer. Functional outcomes were measured using the BBB score, muscle mass, and histological assessment.

Results

At 12 and 16 weeks postoperatively, the rats in the experimental group exhibited recovery to a stronger stretch force of the knee and higher BBB score, as compared to the control group (p < 0.05). The muscle mass and myofiber cross-sectional area of the quadriceps were heavier and larger than those in the control group (p < 0.05). A regenerated nerve with myelinated and unmyelinated fibers was observed in the experimental group. No significant differences were observed between groups at 8 weeks postoperatively (p > 0.05).

Conclusions

Obturator nerve transfer for repairing femoral nerve injury was feasible and effective in a rat model, and can hence be considered as an option for the treatment of femoral nerve injury.

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Zusatzmaterial
Online Resource 1 The video which was made at 16 weeks after the surgery. It demonstrated the stretch strength of the knee recovered after the surgery. (MP4 5213 kb)
701_2018_3565_MOESM1_ESM.mp4
Literatur
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