Turcsanyi Istvan, Fridén Jan
Department of Orthopaedics, Jósa András County Hospital, Nyíregyháza, Hungary.
Scand J Plast Reconstr Surg Hand Surg. 2010 Jun;44(3):156-62. doi: 10.3109/02844311.2010.488886.
Our aim was to evaluate the functional outcome of reconstruction of elbow extension in tetraplegia using a new technique for improving the attachment sites of posterior deltoid-to-triceps transfer in conjunction with an active rehabilitation programme. Ten tetraplegic patients (15 arms) had modified deltoid-to-triceps transfer using a tibialis anterior tendon graft. The operation included large overlaps between the tendon attachments, and additional security by anchoring the distal stump of the tendon graft to the olecranon. During the first 3 weeks of immobilisation, isometric contractions were made and during the following 4 weeks the flexion angle of the elbow was increased by 15 degrees a week; weights were also used to reinforce muscle strength. The mean follow up was 10 months (range 5-19). The elbow extension strength after posterior deltoid-to-triceps transfer was measured in horizontal and vertical planes. After rehabilitation the active range of motion and strength of elbow extension had improved substantially. The mean active elbow extension range of motion was 132 degrees (range 120 degrees -145 degrees ) and the elbow could be extended actively in all planes. Elbow extension strength was restored to well above the counteraction of the weight of the arm. Mean (SEM) elbow extension was significantly greater in the horizontal shoulder plane compared with the vertical plane (10.4 (1.0) compared with 6.5 (1.2) Nm, p < 0.001) and strength increased roughly linearly as the degree of flexion of the elbow increased. The most dramatic increase was in the range between 120 degrees and 135 degrees of flexion, regardless of the plane of action of the shoulder. We have shown good functional results and a shorter rehabilitation period using a rigorous suturing technique that allows for active strength and mobility training without additional adverse effects.
我们的目的是评估采用一种新技术重建四肢瘫患者肘关节伸展功能的效果，该技术可改善三角肌后束至肱三头肌转移的附着点，并结合积极的康复计划。10例四肢瘫患者（15侧上肢）采用胫骨前肌腱移植进行改良的三角肌至肱三头肌转移。手术包括肌腱附着处的大面积重叠，并通过将肌腱移植的远端残端固定在尺骨鹰嘴来增加安全性。在固定的前3周进行等长收缩，在接下来的4周，肘关节的屈曲角度每周增加15度；还使用重物来增强肌肉力量。平均随访10个月（范围5 - 19个月）。在水平和垂直平面测量三角肌后束至肱三头肌转移后的肘关节伸展力量。康复后，肘关节伸展的主动活动范围和力量有了显著改善。肘关节伸展的平均主动活动范围为132度（范围120度 - 145度），并且肘关节可以在所有平面上主动伸展。肘关节伸展力量恢复到远高于手臂重量的对抗力。与垂直平面相比，水平肩关节平面的平均（标准误）肘关节伸展力量显著更大（分别为10.4（1.0）与6.5（1.2）牛米，p < 0.001），并且力量随着肘关节屈曲程度的增加大致呈线性增加。无论肩关节的作用平面如何，最显著的增加发生在120度至135度的屈曲范围内。我们已经证明，使用一种严格的缝合技术可取得良好的功能结果，并缩短康复期，该技术允许进行主动力量和活动度训练，且无额外不良影响。
