Terzis Julia K, Kokkalis Zinon T
Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, VA 23501, USA.
J Pediatr Orthop. 2010 Mar;30(2):161-8. doi: 10.1097/BPO.0b013e3181cf2e82.
Elbow extension is important for the elbow joint, and it is more difficult to restore with microsurgery than elbow flexion. The purpose of this article is to describe the experience of the authors with elbow extension reconstruction in obstetric brachial plexus palsy patients. The outcomes were analyzed in relation to the type of brachial plexus lesion, timing of surgery, and the type of nerve reconstruction.
Fifty-five children with obstetric brachial plexus palsy who underwent nerve reconstruction for elbow extension restoration were studied. The mean follow-up period was 6.4 years (range, 2-22 y). Reinnervation of the triceps muscle was accomplished with indirect neurotization of the posterior cord from intraplexus donors or with direct neurotization from extraplexus donors, such as the contralateral C7 and the intercostal nerves.
Thirty-seven (67%) of the 55 cases showed good or excellent results (>or=M3+). The average postoperative muscle grading for the triceps was 3.34+/-0.99 compared with 1.19+/-1.29 preoperatively (P<0.0001). Patients with C5 to C7 palsy achieved significantly stronger elbow extension than those with C5 to T1 palsy. In addition, the timing of surgery significantly influenced the final outcome.
Elbow extension is one of big challenges to be restored, especially in obstetric brachial plexus palsy. In early cases (within 6 mo) intraplexus reconstruction of the posterior cord can give excellent results. In later cases, or in cases of multiple avulsions, extraplexus motor donors, which selectively targeted the triceps, can give variable results.
肘关节伸展功能对于肘关节至关重要，并且与肘关节屈曲相比，通过显微外科手术恢复该功能更为困难。本文旨在描述作者在产科臂丛神经麻痹患者中进行肘关节伸展功能重建的经验。对结果进行了分析，涉及臂丛神经损伤类型、手术时机以及神经重建类型。
研究了55例因产科臂丛神经麻痹而接受神经重建以恢复肘关节伸展功能的儿童。平均随访期为6.4年（范围2 - 22年）。通过从神经丛内供体对后束进行间接神经化或从神经丛外供体（如对侧C7和肋间神经）进行直接神经化来实现肱三头肌的再支配。
55例患者中有37例（67%）显示良好或优秀的结果（≥M3 +）。肱三头肌术后平均肌力分级为3.34±0.99，术前为1.19±1.29（P < 0.0001）。C5至C7麻痹的患者比C5至T1麻痹的患者实现了明显更强的肘关节伸展。此外，手术时机对最终结果有显著影响。
肘关节伸展功能的恢复是一大挑战，尤其是在产科臂丛神经麻痹中。在早期病例（6个月内），对后束进行神经丛内重建可取得优异结果。在晚期病例或多处撕脱伤病例中，选择性针对肱三头肌的神经丛外运动供体可产生不同的结果。
