Mohammed K D, Rothwell A G, Sinclair S W, Willems S M, Bean A R
Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.
J Bone Joint Surg Br. 1992 Nov;74(6):873-9. doi: 10.1302/0301-620X.74B6.1447249.
We reviewed the results of reconstruction of 97 upper limbs in a consecutive series of 57 tetraplegic patients, treated from 1982 to 1990. Of these, 49 had functional and eight had cosmetic reconstructions. The principal functional objectives were to provide active elbow extension, hook grip, and key pinch. Elbow extension was provided in 34 limbs, using deltoid-to-triceps transfer. Hook grip was provided in 58 limbs, mostly using extensor carpi radialis longus to flexor pollicis longus transfer, and key pinch in 68, mostly using brachioradialis to flexor pollicis longus transfer. Many other procedures were employed. At an average follow-up of 37 months, 70% had good or excellent subjective results, and objective measurements of function compared favourably with other series. Revisions were required for 11 active transfers and three tenodeses, while complications included rupture of anastomoses and problems with thumb interphalangeal joint stabilisation and wound healing. We report a reliable clinical method for differentiating between the activity of extensor carpi radialis longus and brevis and describe a successful new split flexor pollicis longus tenodesis for stabilising the thumb interphalangeal joint. Bilateral simultaneous surgery gave generally better results than did unilateral surgery.
我们回顾了1982年至1990年期间连续收治的57例四肢瘫痪患者中97例上肢重建的结果。其中，49例进行了功能性重建，8例进行了美容性重建。主要的功能目标是实现主动伸肘、钩状抓握和对掌捏物。34例上肢通过三角肌至肱三头肌转移实现了伸肘。58例上肢实现了钩状抓握，大多采用桡侧腕长伸肌至拇长屈肌转移；68例实现了对掌捏物，大多采用肱桡肌至拇长屈肌转移。还采用了许多其他手术方法。平均随访37个月时，70%的患者主观结果为良好或优秀，功能的客观测量结果与其他系列相比也较为理想。11例主动转移和3例肌腱固定术需要进行翻修，并发症包括吻合口破裂、拇指指间关节稳定问题和伤口愈合问题。我们报告了一种可靠的临床方法，用于区分桡侧腕长伸肌和桡侧腕短伸肌的活动，并描述了一种成功的新型拇长屈肌分裂肌腱固定术，用于稳定拇指指间关节。双侧同时手术的效果通常优于单侧手术。
