Estrella Emmanuel P, Favila Arnaldo S
Microsurgery Unit, Department of Orthopedics, Philippine General Hospital, University of the Philippines-Manila, College of Medicine, Manila, Philippines.
J Reconstr Microsurg. 2014 Jan;30(1):59-64. doi: 10.1055/s-0033-1354737. Epub 2013 Sep 9.
The objective of this article was to evaluate the clinical results of nerve transfer procedures for the restoration of shoulder abduction and external rotation in patients with traumatic brachial plexus injuries. A retrospective study was done to determine the results of nerve transfers for shoulder function in patients with traumatic brachial plexus injuries. The authors evaluated shoulder abduction and external rotation in terms of type of nerve transfer performed (single vs. double) and the time delay to surgery (greater or less than 6 mo). A total of 20 patients were evaluated with 5 patients having double nerve transfers and 15 patients having single nerve transfers to restore shoulder function. All surgeries were done within 12 months of injury. The average follow-up for the 20 patients was 28.4 ± 17.5 months (minimum of 12 mo follow-up for all patients). The mean shoulder abduction and external rotation for the single nerve transfer group was 71.3 ± 48 degrees and 56 ± 44 degrees, respectively. For the double nerve transfer group, the mean shoulder abduction and external rotation was 123 ± 49 degrees and 86 ± 35 degrees, respectively. The difference was significant for the shoulder abduction (p = 0.05) but not for the external rotation (p = 0.19). In terms of time delay to surgery, there was no difference between surgery done in 6 months or less versus those done greater than 6 months but less than 12 months for shoulder abduction (88.1 ± 47.7 degrees and 77.1 ± 63.4 degrees, respectively, p = 0.67) and shoulder external rotation (63.8 ± 42.2 degrees and 62.8 ± 49.3 degrees, respectively, p = 0.96). The results of this study showed that nerve transfers can restore functional shoulder abduction and external rotation. Double nerve transfers tend to have significantly greater range of shoulder abduction compared with single nerve transfers if done within 1 year of injury.
本文的目的是评估神经移位手术对创伤性臂丛神经损伤患者恢复肩部外展和外旋功能的临床效果。进行了一项回顾性研究，以确定神经移位手术对创伤性臂丛神经损伤患者肩部功能的治疗效果。作者根据所施行的神经移位类型（单神经移位与双神经移位）以及手术延迟时间（大于或小于6个月），对肩部外展和外旋功能进行了评估。共有20例患者接受评估，其中5例行双神经移位手术，15例行单神经移位手术以恢复肩部功能。所有手术均在受伤后12个月内完成。20例患者的平均随访时间为28.4±17.5个月（所有患者的最短随访时间为12个月）。单神经移位组的平均肩部外展和外旋角度分别为71.3±48度和56±44度。双神经移位组的平均肩部外展和外旋角度分别为123±49度和86±35度。肩部外展角度差异有统计学意义（p = 0.05），但外旋角度差异无统计学意义（p = 0.19）。就手术延迟时间而言，受伤6个月及以内进行手术与受伤大于6个月但小于12个月进行手术相比，肩部外展角度（分别为88.1±47.7度和77.1±63.4度，p = 0.67）和肩部外旋角度（分别为63.8±42.2度和62.8±49.3度，p = 0.96）均无差异。本研究结果表明，神经移位手术可恢复肩部功能性外展和外旋。如果在受伤1年内进行手术，双神经移位相比单神经移位往往能使肩部外展范围显著增大。
