Wangdell Johanna, Fridén Jan
Department of Hand Surgery, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
J Hand Surg Am. 2012 May;37(5):1003-10. doi: 10.1016/j.jhsa.2012.01.026. Epub 2012 Mar 14.
Reconstruction of triceps function in persons with tetraplegia is an established surgical intervention. The purpose of this study was to investigate and evaluate patient perspective of gains in activity and satisfaction after surgical reconstruction of triceps function and subsequent rehabilitation.
We studied the effects of surgery and rehabilitation in 14 persons (19 arms) treated with deltoid-to-triceps transfer. We used Canadian Occupational Performance Measurement standards to capture the performance and satisfaction of patient-identified activity goals. Follow-up was performed at 6 and 12 months postoperatively. To make group analyses, we classified activity goals according to the International Classification of Function, Disability, and Health categories of activities and participation, as well as relative to the position of the arm in space.
Patients reported improvement in performance after surgery, and satisfaction was rated even higher. Improvement was seen in all types of activities that patients had prioritized. No single goal was rated lower at 12 months' follow-up than before surgery. The most common activity gains were related to "driving a wheelchair" and the ability to "reach out," each of which represented 20% of expressed goals. Although "driving a wheelchair" and "moving the body" (transfers) were common goals, the smallest improvements for both performance and satisfaction after 12 months were seen in these areas. We observed the highest performance improvement in the category of "writing" and the ability to "stretch out the arm when lying down."
Improvement in activity continues over the first year after triceps reconstruction. Complex activities continue to improve over a longer period than simpler activities. We saw the highest improvement in activities performed without the aid of gravity and activities highly dependent on coordination. Such actions are difficult to compensate for by technique or skills, and therefore elbow extension is essential for performance.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
重建四肢瘫痪患者的肱三头肌功能是一种既定的外科干预措施。本研究的目的是调查和评估患者对肱三头肌功能手术重建及后续康复后活动能力改善和满意度的看法。
我们研究了14例（19侧手臂）接受三角肌至肱三头肌转移术治疗的患者手术和康复的效果。我们使用加拿大职业表现测量标准来获取患者确定的活动目标的表现和满意度。术后6个月和12个月进行随访。为了进行组间分析，我们根据国际功能、残疾和健康分类的活动和参与类别以及手臂在空间中的位置对活动目标进行分类。
患者报告术后表现有所改善，满意度评价更高。患者优先考虑的所有类型的活动都有改善。在12个月的随访中，没有一个目标的评分低于手术前。最常见的活动改善与“驾驶轮椅”和“伸手”能力有关，每项均占所表达目标的20%。虽然“驾驶轮椅”和“身体移动”（转移）是常见目标，但在这些领域，12个月后表现和满意度的改善最小。我们观察到“书写”类别以及“躺下时伸展手臂”能力的表现改善最为明显。
肱三头肌重建后的第一年活动能力持续改善。复杂活动比简单活动在更长时间内持续改善。我们看到在无重力辅助下进行的活动以及高度依赖协调性的活动中改善最为明显。此类动作难以通过技术或技能来代偿，因此肘关节伸展对于活动表现至关重要。
研究类型/证据水平：治疗性IV级。
