用于恢复固有功能的增压端侧骨间前神经至尺神经运动神经移位术：临床经验
The Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer for Restoring Intrinsic Function: Clinical Experience.
作者信息
Davidge Kristen M, Yee Andrew, Moore Amy M, Mackinnon Susan E
机构信息
St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery, Washington University of St. Louis.
出版信息
Plast Reconstr Surg. 2015 Sep;136(3):344e-352e. doi: 10.1097/PRS.0000000000001514.
BACKGROUND
The authors reviewed their initial clinical experience with the supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer and refined their indications for this technique.
METHODS
A retrospective cohort study was performed of all patients undergoing the supercharge end-to-side procedure from 2009 to 2012. Preoperative and intraoperative data were reviewed. Function was evaluated using manual muscle testing; pinch/grip strength; and Disabilities of the Arm, Shoulder and Hand questionnaire scores. Differences in preoperative and postoperative function were evaluated using paired t tests and Wilcoxon signed rank tests. Predictors of poor outcome and changes in outcome over time were also analyzed.
RESULTS
Fifty-five patients (69 percent men; mean age, 50.0 ± 15.5 years) were included. Diagnoses were varied, but all patients demonstrated clinically significant ulnar intrinsic weakness and electrodiagnostic evidence of denervation of the first dorsal interosseous muscle. Postoperative first dorsal interosseous strength; key pinch strength; grip strength; and Disabilities of the Arm, Shoulder and Hand questionnaire scores improved significantly from baseline at a mean follow-up of 8.0 ± 5.7 months. No patients demonstrated weakness of pronation postoperatively. Absent preoperative compound muscle action potentials in the ulnar nerve significantly predicted poor intrinsic muscle recovery. The degree of intrinsic recovery attributable to the supercharge end-to-side transfer was difficult to determine.
CONCLUSIONS
The supercharge end-to-side anterior interosseous-to-ulnar nerve transfer may be a useful technique for augmenting intrinsic muscle function for severe, in-continuity lesions of the ulnar nerve where limited surgical options exist. Future research is required to determine the proportion of intrinsic recovery attributable to this transfer.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
作者回顾了他们在增压端侧骨间前神经至尺神经运动神经转位方面的初步临床经验，并完善了该技术的适应证。
方法
对2009年至2012年期间所有接受增压端侧手术的患者进行了一项回顾性队列研究。回顾了术前和术中数据。使用徒手肌力测试、捏力/握力以及手臂、肩部和手部功能障碍问卷评分来评估功能。使用配对t检验和Wilcoxon符号秩检验评估术前和术后功能的差异。还分析了预后不良的预测因素以及随时间的预后变化。
结果
纳入了55例患者（69%为男性；平均年龄50.0±15.5岁）。诊断各不相同，但所有患者均表现出临床上明显的尺侧固有肌无力以及第一背侧骨间肌失神经的电诊断证据。在平均随访8.0±5.7个月时，术后第一背侧骨间肌力量、关键捏力、握力以及手臂、肩部和手部功能障碍问卷评分较基线有显著改善。术后没有患者表现出旋前肌无力。术前尺神经复合肌肉动作电位缺失显著预示着固有肌恢复不良。难以确定增压端侧转位所致固有肌恢复的程度。
结论
对于尺神经严重连续性损伤且手术选择有限的情况，增压端侧骨间前神经至尺神经转位可能是增强固有肌功能的一种有用技术。需要进一步研究来确定这种转位所致固有肌恢复的比例。
临床问题/证据水平：治疗性，IV级。
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