Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
Neurosurgery. 2013 May;72(5):709-14; discussion 714-5; quiz 715. doi: 10.1227/NEU.0b013e318285c3f6.
The recovery of elbow flexion in upper brachial plexus injury can be achieved by the reinnervation of the biceps muscle (single reinnervation), but concomitant restoration of brachialis and biceps function (double reinnervation) has been recommended to improve elbow flexion strength.
To prospectively compare morbidity and outcomes of single or double muscle reinnervation in restoring elbow flexion following incomplete injury to the brachial plexus.
Forty consecutive patients were prospectively submitted to single or double muscle reinnervation. Elbow flexion strength was evaluated with a push-and-pull dynamometer 12 months after surgery. Hand morbidity related to the procedures was evaluated by the Semmes-Weinstein monofilaments test, quantification of static 2-point discrimination, and measurements of handgrip and lateral pinch strength in serial evaluations up to the final follow-up.
Similar results for the strength of elbow flexion were observed in both groups. A worsening of sensibility, measured by using Semmes-Weinstein monofilaments, was identified in 8 patients, all of whom showed recovery during follow-up. No worsening of 2-point discrimination was observed. A decrease in handgrip and lateral pinch strength was identified in 8 and 9 patients, respectively, which improved during follow-up. There was no difference between the groups in the incidence of hand motor morbidity parameters.
The strength of elbow flexion did not differ significantly between the groups treated with single or double muscle reinnervation. Deterioration of handgrip, lateral pinch strength, and sensibility measured by using Semmes-Weinstein monofilaments, was temporary, resulting in low morbidity for both techniques.
在上臂丛神经损伤中，通过二头肌的再神经支配（单神经再支配）可以恢复肘部屈曲，但同时恢复肱肌和二头肌的功能（双神经再支配）已被推荐用于改善肘部屈曲力量。
前瞻性比较不完全性臂丛神经损伤后单肌或双肌再神经支配恢复肘部屈曲的发病率和结果。
连续 40 例患者前瞻性地接受单肌或双肌再神经支配。术后 12 个月，使用推-拉测力计评估肘部屈曲强度。通过 Semmes-Weinstein 单丝试验、静态 2 点辨别力定量、手抓握和侧捏力量测量，在系列评估中评估与手术相关的手部发病率，直至最终随访。
两组肘部屈曲强度的结果相似。8 例患者出现感觉恶化，用 Semmes-Weinstein 单丝测量，所有患者在随访中均恢复。2 点辨别力无恶化。8 例和 9 例患者分别出现握力和侧捏力下降，随访时均有所改善。两组手部运动发病率参数的发生率无差异。
单肌或双肌再神经支配治疗组的肘部屈曲强度无显著差异。用 Semmes-Weinstein 单丝测量的握力、侧捏力和感觉恶化是暂时的，两种技术的发病率都较低。
