Hand and Upper Extremity Surgery Department, Lapeyronie Teaching Regional Hospital Center, 371, avenue du Doyen-Gaston-Giraud, Montpellier cedex 5, France.
Orthop Traumatol Surg Res. 2011 Dec;97(8):785-92. doi: 10.1016/j.otsr.2011.07.012. Epub 2011 Nov 22.
Restoration of elbow flexion is an important step in managing brachial plexus injuries. After more than one year of functional denervation, the muscle atrophy is significant enough that transferring a free muscle to act as a new effector becomes a treatment option. The goal of this study was to evaluate the effectiveness of transferring a gracilis free muscle, innervated by three intercostal nerves, to restore elbow flexion.
This was a retrospective study of a series of gracilis transfer procedures in 12 men having an average age of 25.6 years (23-37) and average follow-up of 112 months (28-260). The patients were operated on average at 42 months (14-153) following their motor vehicle accident; five had a partial paralysis (C5C6C7) and seven had a complete paralysis (C5-T1). The surgical technique and rehabilitation protocol were the same for all the patients.
There were two cases of acute arterial thrombosis (17%) that led to functional failure. When these two cases were excluded from the analysis, all the remaining patients had a useful result (British Medical Research Council score ≥ M4) and 2.5 kg of elbow flexion strength measured on a dynamometer. The strength was 3.8 kg (2.7 to 55) for partial plexus injuries and 1.6 kg (0.3 to 1.5) for complete plexus injuries. For partial injuries, active elbow flexion was 128° and extension -38°, versus 103° and -23° for complete injuries. The average DASH score was 42 for partial injuries and 32 for complete injuries.
Free Gracilis muscle transfer is a challenging technique that leads to reproducible and encouraging results, but has vascular failure rate that cannot be ignored. When compared to published results, our series provides similar results to primary suturing performed within 6 months for cases of complete paralysis and within 12 months for cases of C5C6C7 partial paralysis; our series was better for cases beyond 12 months.
恢复肘部弯曲是治疗臂丛神经损伤的重要步骤。在经历一年以上的功能失神经后，肌肉萎缩非常明显，此时可以选择转移游离肌肉作为新的效应器。本研究旨在评估通过神经移植三对肋间神经来转移游离股薄肌以恢复肘部弯曲的效果。
这是一项回顾性研究，纳入了 12 名男性患者（平均年龄 25.6 岁，23-37 岁），共进行了 12 例游离股薄肌转位术。所有患者的平均随访时间为 112 个月（28-260 个月）。患者平均在车祸后 42 个月（14-153 个月）接受手术，5 例部分瘫痪（C5C6C7），7 例完全瘫痪（C5-T1）。所有患者均采用相同的手术技术和康复方案。
有 2 例（17%）发生急性动脉血栓形成导致功能失败。将这 2 例排除后，其余所有患者均获得了有用的结果（英国医学研究理事会评分≥M4），并使用测力计测量到 2.5kg 的肘部弯曲力量。部分臂丛损伤患者的力量为 3.8kg（2.7-55），完全臂丛损伤患者的力量为 1.6kg（0.3-1.5）。部分损伤患者的主动肘部弯曲为 128°，伸展为-38°，完全损伤患者的主动肘部弯曲为 103°，伸展为-23°。部分损伤患者的 DASH 评分为 42，完全损伤患者的 DASH 评分为 32。
游离股薄肌转位是一种具有挑战性的技术，可获得可重复且令人鼓舞的结果，但存在不容忽视的血管失败率。与已发表的结果相比，我们的研究结果与完全瘫痪患者 6 个月内、C5C6C7 部分瘫痪患者 12 个月内进行的初次缝合结果相似；我们的研究结果在 12 个月后更好。
