Altintas A A, Altintas M A, Gazyakan E, Gohla T, Germann G, Sauerbier M
Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, Cologne, Plastic and Hand Surgery, University of Witten Herdecke, Cologne, Germany.
J Hand Surg Am. 2009 Mar;34(3):474-8. doi: 10.1016/j.jhsa.2008.11.012.
Radial nerve damage results in substantial functional limitations of the upper extremity. No detailed data exist regarding long-term results, patient satisfaction, and professional and social reintegration after tendon transfer for irreparable damage to the radial nerve. In this retrospective study, we investigated these data through the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
Between 1995 and 2006, 77 patients underwent a modified Brooks and d'Aubigne surgical technique for radial nerve palsy in our department. In 19 cases, the flexor carpi radialis muscle was used as a donor instead of the flexor carpi ulnaris muscle. The mean follow-up period was 60 months (range, 24-150 months); motion of the wrist and finger joints and pinch-grip power were compared with the healthy side. We assessed the limitation in pursuing daily activities using the DASH score.
Wrist extension averaged 73% of the contralateral side, whereas the value for movement of digital extension was 32% and for thumb abduction in the palmar direction it was 80%. The power grip was reduced to 49% and the pinch grip was reduced to 28%. The mean DASH score was 15 +/- 9, the symptom score mean was 15 +/- 7, and the working score mean was 12 +/- 10. The mean total DASH score was 16 +/- 10. The proportion of patients who remained employed after surgical treatment was 89%.
Functional results, adequate patient satisfaction, and sufficient professional and social reintegration can be achieved after modified Brooks and d'Aubigne tendon transfer. Accordingly, the tendon transfer offers an important alternative-possibly the procedure of choice-to microsurgical nerve reconstruction, particularly when early professional and social reintegration is important.
桡神经损伤会导致上肢出现严重的功能受限。目前尚无关于桡神经不可修复性损伤行肌腱转位术后长期疗效、患者满意度以及职业和社会重新融入情况的详细数据。在这项回顾性研究中，我们通过上肢、肩部和手部功能障碍（DASH）问卷对这些数据进行了调查。
1995年至2006年间，我们科室有77例患者因桡神经麻痹接受了改良的布鲁克斯和达比涅手术技术。其中19例使用桡侧腕屈肌作为供体，而非尺侧腕屈肌。平均随访时间为60个月（范围24 - 150个月）；将腕关节和手指关节的活动度以及捏握力与健侧进行比较。我们使用DASH评分评估日常活动的受限情况。
腕关节伸展平均为对侧的73%，而手指伸展活动度为32%，拇指掌侧外展为80%。强力握力降至49%，捏握力降至28%。平均DASH评分为15±9，症状评分为15±7，工作评分为12±10。DASH总分平均为16±10。手术治疗后仍在职的患者比例为89%。
改良的布鲁克斯和达比涅肌腱转位术后可取得良好的功能结果、足够的患者满意度以及充分的职业和社会重新融入。因此，肌腱转位为显微外科神经重建提供了一种重要的替代方法——可能是首选方法——特别是在早期职业和社会重新融入很重要的情况下。
