Frueh Florian S, Ho Michael, Schiller Andreas, Ducommun Pascal, Manoliu Andrei, Andreisek Gustav, Calcagni Maurizio, Giovanoli Pietro
From the *Division of Plastic Surgery and Hand Surgery, and †Institute of Diagnostic and Interventional Radiology, University Hospital Zürich, University of Zürich, Rämistrasse, Zürich; and ‡Radiology, Cantonal Hospital Münsterlingen, Spital Thurgau, Spitalcampus, Münsterlingen, Switzerland.
Ann Plast Surg. 2017 Jan;78(1):67-72. doi: 10.1097/SAP.0000000000000924.
The primary goal of the surgical treatment of upper brachial plexus injuries is to restore active elbow flexion. Accordingly, Oberlin's transfer has been frequently performed since 1994 and has influenced the development of other nerve transfers. However, the window of opportunity for nerve transfers remains a subject of controversy. The objective of this study was to assess magnetic resonance (MR) neurographic, clinical and electrophysiological long-term results after Oberlin's transfer. For this purpose, we performed a retrospective follow-up study. Six patients with upper brachial plexus or musculocutaneous nerve injuries were assessed; 2 were iatrogenic nerve injuries following shoulder arthroscopy or neurofibroma resection. Direct and indirect signs of neuropathy were objectified with MR neurography. Moreover, clinical and electrodiagnostic follow-up was performed and all patients completed the Disabilities of Arm, Shoulder and Hand score. Mean follow-up was 48 ± 21.9 (range, 20-73) months. Mean age was 40 ± 11.3 years and mean delay to surgery was 9 ± 3.2 months. All patients were satisfied with the functional results and the median Disabilities of Arm, Shoulder and Hand score was 21 (range, 1-57). Biceps strength was improved in 5 patients from Medical Research Council grade M0 to M4-5 and in one patient to M2-3. The donor nerve showed normal motor and sensory action potentials. Follow-up MR neurography demonstrated biceps reinnervation. Taken together, this study reports good long-term results after Oberlin's transfer. MR neurography represents an excellent, noninvasive preoperative planning tool and can be of high value in selected postoperative cases. The combined evaluation of nerves and muscles may help to indicate nerve transfers in delayed cases.
上臂丛神经损伤手术治疗的主要目标是恢复主动屈肘功能。因此，自1994年以来，奥伯林移位术被频繁施行，并影响了其他神经移位术的发展。然而，神经移位术的时机选择仍存在争议。本研究的目的是评估奥伯林移位术后磁共振（MR）神经成像、临床及电生理方面的长期结果。为此，我们进行了一项回顾性随访研究。对6例上臂丛神经或肌皮神经损伤患者进行了评估；其中2例为肩关节镜检查或神经纤维瘤切除术后的医源性神经损伤。通过MR神经成像将神经病变的直接和间接征象客观化。此外，进行了临床和电诊断随访，所有患者均完成了手臂、肩部和手部功能障碍评分。平均随访时间为48±21.9（范围20 - 73）个月。平均年龄为40±11.3岁，平均手术延迟时间为9±3.2个月。所有患者对功能结果均满意，手臂、肩部和手部功能障碍评分的中位数为21（范围1 - 57）。5例患者的肱二头肌力量从医学研究委员会（Medical Research Council）分级的M0级提高到M4 - 5级，1例患者提高到M2 - 3级。供体神经显示运动和感觉动作电位正常。随访MR神经成像显示肱二头肌重新获得神经支配。综上所述，本研究报告了奥伯林移位术后良好的长期结果。MR神经成像代表了一种出色的无创术前规划工具，在部分术后病例中可能具有很高的价值。对神经和肌肉的综合评估可能有助于在延迟病例中指明神经移位术。
