Functional outcome and histologic analysis of late onset total type brachial plexus injury treated with intercostal nerve transfer to median nerve with local umbilical cord-derived mesenchymal stem cells or secretome injection: a double-blinded, randomized control study

被引：1

作者：

Widodo, Wahyu ^{[1
,2
,3
]}

Dilogo, Ismail Hadisoebroto ^{[2
]}

Kamal, Achmad Fauzi ^{[2
]}

Antarianto, Radiana Dhewayani ^{[4
,5
]}

Wuyung, Puspita Eka ^{[6
]}

Siregar, Nurjati Chairani ^{[6
]}

Octaviana, Fitri ^{[7
]}

Kekalih, Aria ^{[8
]}

Suroto, Heri ^{[9
]}

Latief, Wildan ^{[2
]}

Hutami, Witantra Dhamar ^{[2
]}

机构：

[1] Univ Indonesia, Doctoral Program Med Sci, Fac Med, Jakarta, Indonesia

[2] Univ Indonesia, Cipto Mangunkusumo Natl Cent Publ Hosp, Fac Med, Orthoped & Traumatol Dept, Jakarta, Indonesia

[3] Fatmawati Gen Hosp, Orthoped & Traumatol Dept, Jakarta, Indonesia

[4] Univ Indonesia, Fac Med, Histol Dept, Jakarta, Indonesia

[5] Univ Indonesia, Fac Med, Stem Cell & Tissue Engn Res Cluster IMERI, Jakarta, Indonesia

[6] Univ Indonesia, Cipto Mangunkusumo Natl Gen Hosp, Fac Med, Anat Pathol Dept, Jakarta, Indonesia

[7] Univ Indonesia, Cipto Mangunkusumo Natl Gen Hosp, Fac Med, Neurol Dept, Jakarta, Indonesia

[8] Univ Indonesia, Fac Med, Community Med Dept, Jakarta, Indonesia

[9] Univ Airlangga, Dr Soetomo Gen Hosp, Fac Med, Orthoped & Traumatol, Surabaya, Indonesia

来源：

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY | 2024年 / 34卷 / 08期

关键词：

Brachial plexus injury; Stem cells; Secretome; Neuromuscular junction; Clinical outcomes; PROSPECT; MUSCLE;

D O I：

10.1007/s00590-024-04110-6

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

IntroductionIntercostal nerve transfer is a surgical technique used to restore function in patients with total brachial plexus injury. Stem cell and secretome therapy has been explored as a potential treatment for brachial plexus injuries. This study aimed to compare the functional and histologic outcome of intercostal nerve transfer to median nerve with local stem cells or secretome injection in total type brachial plexus injuries.Materials and methodsThis was a double-blinded, randomized controlled study (RCT). We included patients with neglected total type brachial plexus injury (BPI) who underwent nerve transfer and local injection of either umbilical cord-derived mesenchymal stem cells (UC-MSC) or secretome into median nerve-flexor digitorum superficialis (FDS) neuromuscular junction (NMJ). We measured preoperative and 8-month postoperative FDS muscle strength, SF-36, DASH score, and histologic assessment. We then analyzed the difference outcome between those two groups.ResultA total of 15 patients were included in this study. Our study found that after nerve transfer and implantation with either UC-MSC or secretome, significant postoperative improvements were observed in physical functioning, role limitations, energy/fatigue, emotional well-being, social functioning, pain, general health, and DASH scores, particularly in the overall cohort and the secretome group. When we compared the mean difference of clinical outcome from preoperative to postoperative between UC-MSC and secretome groups, the UC-MSC group showed better improvement of health change in SF-36 subgroup compared to secretome group. From the analysis, there was no significant difference in the histologic outcomes (inflammation, regeneration, and fibrosis) in overall cohort between preoperative and postoperative cohort. There was also no significant difference in mean change of the histologic outcomes (inflammation, regeneration, and fibrosis) preoperative and postoperatively between UC-MSC and secretome groups.Discussion and conclusionImplantation of either UC-MSC or secretome along with nerve transfer may provide clinical improvement, while to achieve histologic improvement, further conditioning should be performed.

引用

页码：4073 / 4082

页数：10