de Mendonça Cardoso Marcio, Gepp Ricardo, Correa José Fernando Guedes
Department of Neurological Surgery, Sarah Network of Rehabilitation Hospitals, 70673-208, SQSW 302, Brasilia, Brazil.
Peripheral Nerve Surgery Unit, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Acta Neurochir (Wien). 2016 Sep;158(9):1793-800. doi: 10.1007/s00701-016-2855-8. Epub 2016 Jun 4.
The phrenic nerve can be transferred to the musculocutaneous nerve in patients with traumatic brachial plexus palsy in order to recover biceps strength, but the results are controversial. There is also a concern about pulmonary function after phrenic nerve transection. In this paper, we performed a qualitative systematic review, evaluating outcomes after this procedure.
A systematic review of published studies was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Data were extracted from the selected papers and related to: publication, study design, outcome (biceps strength in accordance with BMRC and pulmonary function) and population. Study quality was assessed using the "strengthening the reporting of observational studies in epidemiology" (STROBE) standard or the CONSORT checklist, depending on the study design.
Seven studies were selected for this systematic review after applying inclusion and exclusion criteria. One hundred twenty-four patients completed follow-up, and most of them were graded M3 or M4 (70.1 %) for biceps strength at the final evaluation. Pulmonary function was analyzed in five studies. It was not possible to perform a statistical comparison between studies because the authors used different parameters for evaluation. Most of the patients exhibited a decrease in pulmonary function tests immediately after surgery, with recovery in the following months. Study quality was determined using STROBE in six articles, and the global score varied from 8 to 21.
Phrenic nerve transfer to the musculocutaneous nerve can recover biceps strength ≥M3 (BMRC) in most patients with traumatic brachial plexus injury. Early postoperative findings revealed that the development of pulmonary symptoms is rare, but it cannot be concluded that the procedure is safe because there is no study evaluating pulmonary function in old age.
对于创伤性臂丛神经麻痹患者，可将膈神经转移至肌皮神经以恢复肱二头肌力量，但结果存在争议。膈神经横断后对肺功能也存在担忧。在本文中，我们进行了一项定性系统评价，评估该手术后的结果。
根据系统评价和Meta分析的首选报告项目（PRISMA）声明，对已发表的研究进行系统评价。从选定的论文中提取数据，涉及：发表情况、研究设计、结果（根据英国医学研究委员会标准的肱二头肌力量和肺功能）及人群。根据研究设计，使用“加强流行病学观察性研究报告”（STROBE）标准或CONSORT清单评估研究质量。
应用纳入和排除标准后，选择了7项研究进行该系统评价。124例患者完成随访，最终评估时大多数患者肱二头肌力量分级为M3或M4（70.1%）。5项研究分析了肺功能。由于作者使用不同参数进行评估，无法在研究之间进行统计学比较。大多数患者术后立即肺功能测试结果下降，随后数月恢复。6篇文章使用STROBE确定研究质量，总体评分从8分到21分不等。
膈神经转移至肌皮神经可使大多数创伤性臂丛神经损伤患者的肱二头肌力量恢复至≥M3（英国医学研究委员会标准）。术后早期结果显示肺部症状的发生罕见，但由于没有研究评估老年患者的肺功能，不能得出该手术是安全的结论。
