Nath Rahul K, Kumar Nirupuma, Somasundaram Chandra
Texas Nerve and Paralysis Institute, 6400 Fannin st, Houston, TX 77030, USA.
Ann Surg Innov Res. 2013 May 28;7:5. doi: 10.1186/1750-1164-7-5. eCollection 2013.
Nerve conduction studies or somatosensory evoked potentials (SSEPs) have become an important tool in the investigation of peripheral nerve lesions, and is sensitive in detecting brachial plexus nerve injury, and other nerve injuries. To investigate whether the modified Quad surgical procedure improves nerve conductivity and functional outcomes in obstetric brachial plexus nerve injury (OBPI) patients.
All nerves were tested with direct functional electrical stimulation. A Prass probe was used to stimulate the nerves, and recording the response, the compound motor action potential (CMAP) in the muscle. SSEP monitoring was performed pre- and post modified Quad surgery, stimulating the median and ulnar nerves at the wrist, the radial nerve over the dorsum of the hand, recording the peripheral, cervical and cortical responses. All patients have had the modified Quad surgery (n = 19). The modified Quad surgery is a muscle release and transfer surgery with nerve decompressions. All patients were assessed preoperatively and postoperatively by evaluating video recordings of standardized movements, the modified Mallet scale to index active shoulder movements.
The cervical responses were significantly lower in amplitude in the affected arm than the un-affected arm. The median nerve conduction was significantly improved from 8.04 to 9.26 (P < 0.022) post-operatively. The shoulder abduction was also significantly improved (pre-op 30° ± 23.3 to 143° ± 33.7, p < 0.0001), with a mean follow-up of 43 months after the modified Quad surgery in these patients.
Median nerve conduction, and shoulder abduction were significantly improved in OBPI children, who have undergone the modified Quad procedure with neuroplasty, internal microneurolysis and tetanic stimulation of the median nerve.
神经传导研究或体感诱发电位（SSEPs）已成为外周神经损伤研究中的一项重要工具，在检测臂丛神经损伤及其他神经损伤方面较为敏感。旨在研究改良Quad手术是否能改善产科臂丛神经损伤（OBPI）患者的神经传导性及功能预后。
所有神经均采用直接功能性电刺激进行检测。使用Prass探头刺激神经，并记录肌肉中的复合运动动作电位（CMAP）反应。在改良Quad手术前后进行SSEP监测，刺激腕部的正中神经和尺神经、手背处的桡神经，记录外周、颈部及皮质反应。所有患者均接受了改良Quad手术（n = 19）。改良Quad手术是一种伴有神经减压的肌肉松解和转移手术。通过评估标准化动作的视频记录、用于评估主动肩部运动的改良Mallet量表，对所有患者进行术前和术后评估。
患侧手臂的颈部反应幅度明显低于未患侧手臂。术后正中神经传导显著改善，从8.04提升至9.26（P < 0.022）。肩部外展也显著改善（术前30°±23.3至术后143°±33.7，p < 0.0001），这些患者在改良Quad手术后平均随访43个月。
接受了改良Quad手术（包括神经成形术、正中神经内微神经松解术和强直刺激）的OBPI儿童，其正中神经传导和肩部外展得到了显著改善。
