Christian Doppler Laboratory for Restoration of Extremity Function.
Department of Physical Medicine and Rehabilitation; and.
J Neurosurg. 2017 Nov;127(5):1163-1171. doi: 10.3171/2016.6.JNS16154. Epub 2017 Jan 17.
OBJECTIVE Global brachial plexus lesions with multiple root avulsions are among the most severe nerve injuries, leading to lifelong disability. Fortunately, in most cases primary and secondary reconstructions provide a stable shoulder and restore sufficient arm function. Restoration of biological hand function, however, remains a reconstructive goal that is difficult to reach. The recently introduced concept of bionic reconstruction overcomes biological limitations of classic reconstructive surgery to restore hand function by combining selective nerve and muscle transfers with elective amputation of the functionless hand and its replacement with a prosthetic device. The authors present their treatment algorithm for bionic hand reconstruction and report on the management and long-term functional outcomes of patients with global brachial plexopathies who have undergone this innovative treatment. METHODS Thirty-four patients with posttraumatic global brachial plexopathies leading to loss of hand function consulted the Center for Advanced Restoration of Extremity Function between 2011 and 2015. Of these patients, 16 (47%) qualified for bionic reconstruction due to lack of treatment alternatives. The treatment algorithm included progressive steps with the intent of improving the biotechnological interface to allow optimal prosthetic hand replacement. In 5 patients, final functional outcome measurements were obtained with the Action Arm Research Test (ARAT), the Southampton Hand Assessment Procedure (SHAP), and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS In all 5 patients who completed functional assessments, partial hand function was restored with bionic reconstruction. ARAT scores improved from 3.4 ± 4.3 to 25.4 ± 12.7 (p = 0.043; mean ± SD) and SHAP scores improved from 10.0 ± 1.6 to 55 ± 19.7 (p = 0.042). DASH scores decreased from 57.9 ± 20.6 to 32 ± 28.6 (p = 0.042), indicating decreased disability. CONCLUSIONS The authors present an algorithm for bionic reconstruction leading to useful hand function in patients who lack biological treatment alternatives for a stiff, functionless, and insensate hand resulting from global brachial plexopathies.
全球臂丛神经多根撕脱伤是最严重的神经损伤之一，导致终身残疾。幸运的是，在大多数情况下，一期和二期重建可以提供稳定的肩部并恢复足够的手臂功能。然而，恢复生物手功能仍然是一个难以实现的重建目标。最近提出的仿生重建概念通过将选择性神经和肌肉转移与功能丧失的手选择性截肢以及用假肢装置替代相结合，克服了经典重建手术的生物学局限性，从而恢复手功能。作者介绍了他们的仿生手重建治疗算法，并报告了接受这种创新治疗的创伤后全球臂丛神经病导致手部功能丧失的 34 例患者的管理和长期功能结果。
2011 年至 2015 年，中心高级肢体功能重建中心共咨询了 34 例创伤后导致手部功能丧失的全球臂丛神经病患者。其中 16 例（47%）因缺乏治疗选择而符合仿生重建条件。治疗算法包括逐步进行，目的是改善生物技术界面，以实现最佳的假肢手置换。在 5 例患者中，使用 Action Arm Research Test（ARAT）、Southampton Hand Assessment Procedure（SHAP）和 Disabilities of the Arm, Shoulder, and Hand（DASH）问卷获得最终功能评估测量结果。
在所有完成功能评估的 5 例患者中，仿生重建恢复了部分手部功能。ARAT 评分从 3.4 ± 4.3 提高到 25.4 ± 12.7（p = 0.043；平均值 ± 标准差），SHAP 评分从 10.0 ± 1.6 提高到 55 ± 19.7（p = 0.042）。DASH 评分从 57.9 ± 20.6 降低到 32 ± 28.6（p = 0.042），表明残疾程度降低。
作者提出了一种仿生重建算法，为因全球臂丛神经病导致僵硬、无功能和感觉丧失的手而缺乏生物学治疗选择的患者提供有用的手部功能。
