Kita Yusuke, Tajiri Yasuhito, Hoshikawa Shinya, Hara Yukinori, Iijima Junichi
Department of Orthopedic Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
Hand Surg. 2015;20(1):47-52. doi: 10.1142/S0218810415500069.
Brachial plexus injuries (BPI) can be complicated by diaphragmatic paralysis (DP). This study determined the influence of DP on biceps brachii (BB) recovery after intercostal nerve transfer (ICNT) for BPI and investigated the respiratory complications of ICNT. The study included 100 patients, 84 showing no DP in preoperative and early postoperative chest radiographic images (non-DP group) and 16 with DP that persisted for over one year after surgery (DP group). The postoperative reinnervation time did not differ between groups. BB strength one year after surgery was lower in the DP group than non-DP group (p = 0.0007). No differences were observed 2-3 years after surgery. In the DP group, four patients had respiratory symptoms that affected daily activities and their outcomes deteriorated (p = 0.04). Phrenic nerve transfer should not be combined with ICNT in patients with poor respiratory function because of the high incidence of respiratory complications.
臂丛神经损伤（BPI）可能并发膈肌麻痹（DP）。本研究确定了DP对肋间神经转位术（ICNT）治疗BPI后肱二头肌（BB）恢复的影响，并调查了ICNT的呼吸并发症。该研究纳入了100例患者，其中84例在术前和术后早期胸部X线影像中未显示DP（非DP组），16例术后DP持续超过一年（DP组）。两组术后再支配时间无差异。术后一年，DP组的BB肌力低于非DP组（p = 0.0007）。术后2至3年未观察到差异。在DP组中，有4例患者出现影响日常活动的呼吸道症状，其预后恶化（p = 0.04）。由于呼吸并发症发生率高，呼吸功能差的患者不应将膈神经转位与ICNT联合应用。
