Department of Orthopedics, Ogori Daiichi General Hospital, 862-3 Shimogo-Ogori, Yamaguchi 754-0002, Japan.
J Bone Joint Surg Am. 2013 Aug 21;95(16):1505-12. doi: 10.2106/JBJS.K.01279.
Double free muscle transfer for the treatment of traumatic total brachial plexus injury provides useful prehensile function. We studied the outcome of this muscle transfer procedure, including the changes in disability and quality-of-life scores.
Thirty-six patients with traumatic total brachial plexus injury who underwent double free muscle transfer for reconstruction from 2002 to 2008 and had a minimum follow-up of twenty-four months after the second free muscle transfer were studied. All were evaluated preoperatively and postoperatively with use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) questionnaires. A separate questionnaire was used to determine job status, pain, use of the reconstructed hand, and satisfaction with the procedure.
The mean patient age was twenty-nine years (range, sixteen to forty-nine years), and the mean duration of follow-up was thirty-six months (range, twenty-four to seventy-nine months). The mean active range of motion was 23° (range, 0° to 80°) for shoulder flexion, 31° (range, 0° to 90°) for shoulder abduction, -18° (range, -80° to 40°) for shoulder external rotation, 62° (range, 0° to 130°) for the shoulder rotation arc, 119° (range, 90° to 150°) for elbow flexion, and -33° (range, -60° to -20°) for elbow extension. The power of elbow flexion was M4 in twenty-five patients and M3 in eleven. Twenty-three patients had triceps nerve reconstruction; extension was M0 in two of these patients, M1 in seven, M2 in ten, and M3 in four. Total active motion of the fingers was 46° (range, 0° to 98°), with a mean hook grip strength of 4 kg (range, 0 to 12 kg). Wilcoxon tests revealed significant improvements in the DASH score and the SF-36 physical functioning, role physical, and physical component summary scores. The majority of patients worked but had changed their type of work, used the reconstructed hand in activities of daily living that required both hands, and were satisfied with the procedure.
Double free muscle transfer yielded satisfactory function and allowed use of the reconstructed hand in activities that required both hands. The improvement in the DASH score was greater than that in the SF-36 score.
双游离肌肉移植术治疗创伤性全臂丛神经损伤可提供有用的抓握功能。我们研究了这种肌肉移植手术的结果，包括残疾和生活质量评分的变化。
2002 年至 2008 年间，我们对 36 例创伤性全臂丛神经损伤患者进行了双游离肌肉移植术治疗，并在第二次游离肌肉移植后至少随访 24 个月。所有患者均在术前和术后使用上肢功能障碍、肩肘手（DASH）和简化 36 项健康调查量表（SF-36）进行评估。还使用单独的问卷来确定工作状态、疼痛、使用重建手以及对手术的满意度。
患者平均年龄为 29 岁（16-49 岁），平均随访时间为 36 个月（24-79 个月）。主动肩关节活动度的平均值为：肩关节前屈 23°（0-80°），肩关节外展 31°（0-90°），肩关节外旋-18°（-80°-40°），肩关节旋转弧 62°（0-130°），肘关节屈曲 119°（90°-150°），肘关节伸展-33°（-60°-20°）。25 例患者的屈肘肌力为 M4，11 例为 M3。23 例患者行三头肌神经重建，其中 2 例伸肘为 M0，7 例为 M1，10 例为 M2，4 例为 M3。手指总主动活动度为 46°（0-98°），平均钩状握力为 4kg（0-12kg）。Wilcoxon 检验显示 DASH 评分和 SF-36 生理功能、角色生理和生理成分综合评分均有显著改善。大多数患者仍在工作，但已改变工作类型，将重建手用于需要双手的日常生活活动，并对手术满意。
双游离肌肉移植术可获得满意的功能，并允许重建手用于需要双手的活动。DASH 评分的改善大于 SF-36 评分。
