Journal of hand and microsurgery · 2026
Surgical treatment of hourglass-like nerve constrictions with allogeneic nerve: a series report of 4 cases.
СтатьяНазвание и аннотация: Перевод в очереди
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Zhao Minghua, Cao Cuiping, Wang Meng, Wang Haixia, Zhang Haixin, Wang Yifan, Zhao Jian, Gong Xuyin
Аннотация
PURPOSE: Hourglass-like constriction (HGC) is an anatomical finding of peripheral nerves, most commonly associated with immune-mediated inflammatory neuropathies such as neuralgic amyotrophy. Current treatment modalities primarily include conservative observation, neurolysis, autologous nerve grafting, and tendon transfer. Allogeneic nerves, as alternative graft materials for nerve reconstruction, have not been systematically reported in the management of hourglass-like constrictions. This study aimed to report the clinical outcomes of allogeneic nerve reconstruction in carefully selected cases of allogeneic nerve transplantation for treating multi-segmental radial nerve hourglass constrictions.
METHODS: A retrospective analysis was performed on 4 patients (3 males, 1 female) with idiopathic radial nerve palsy treated in our department from February 2019 to February 2022. All cases presented with severe multi-segmental constrictions. Preoperative evaluation included electromyography and high-frequency ultrasound to assess nerve damage. Intraoperatively, constricted segments were completely resected, and allogeneic nerve grafts were used for reconstruction. Postoperative follow-up duration ranged from 18 to 26 months (mean 22 months).
RESULTS: All incisions healed primarily without clinically apparent immune rejection or infection. Motor function was evaluated using the British Medical Research Council (BMRC) muscle strength grading scale, combined with electromyography for nerve regeneration assessment. At 18 months postoperatively, all patients achieved significant recovery of active thumb and finger extension: 3 patients demonstrated M4 strength in extensor pollicis longus and extensor digitorum communis, while 1 patient showed M3 for extensor pollicis longus and M4 for extensor digitorum communis.
CONCLUSION: For severe multi-segmental hourglass-like constrictions, resection combined with nerve grafting is recommended. Allogeneic nerve transplantation may represent a safe and effective treatment option in selected cases of radial nerve hourglass constrictions. However, further large-scale randomized controlled trials are required to validate its long-term efficacy in repairing long-segment, thick mixed nerve defects.
METHODS: A retrospective analysis was performed on 4 patients (3 males, 1 female) with idiopathic radial nerve palsy treated in our department from February 2019 to February 2022. All cases presented with severe multi-segmental constrictions. Preoperative evaluation included electromyography and high-frequency ultrasound to assess nerve damage. Intraoperatively, constricted segments were completely resected, and allogeneic nerve grafts were used for reconstruction. Postoperative follow-up duration ranged from 18 to 26 months (mean 22 months).
RESULTS: All incisions healed primarily without clinically apparent immune rejection or infection. Motor function was evaluated using the British Medical Research Council (BMRC) muscle strength grading scale, combined with electromyography for nerve regeneration assessment. At 18 months postoperatively, all patients achieved significant recovery of active thumb and finger extension: 3 patients demonstrated M4 strength in extensor pollicis longus and extensor digitorum communis, while 1 patient showed M3 for extensor pollicis longus and M4 for extensor digitorum communis.
CONCLUSION: For severe multi-segmental hourglass-like constrictions, resection combined with nerve grafting is recommended. Allogeneic nerve transplantation may represent a safe and effective treatment option in selected cases of radial nerve hourglass constrictions. However, further large-scale randomized controlled trials are required to validate its long-term efficacy in repairing long-segment, thick mixed nerve defects.