Johnsen Parker H, Wolfe Scott W
The Hospital for Special Surgery, New York, NY, USA.
Hand (N Y). 2016 Dec;11(4):NP30-NP33. doi: 10.1177/1558944715627241. Epub 2016 Sep 9.
Conventional wisdom and the available literature demonstrate compromised outcomes following nerve reconstruction for traumatic brachial plexus palsy in the elderly. We present a 74-year-old male who was reconstructed with multiple nerve transfers for brachial plexus palsy after a ski accident. Triceps to axillary nerve transfer, spinal accessory to suprascapular nerve transfer, and ulnar to musculocutaneous nerve transfer were performed 16 weeks post injury. At 11 years post-op, the patient could abduct to 65° and forward flex at M4 strength, limited only by painful glenohumeral arthritis. Elbow flexion was M5- at both the biceps and brachialis, and bulk and tone were nearly symmetrical with the opposite side. Eleven-year electrodiagnostic studies demonstrated reinnervation and improved motor unit recruitment all affected muscles. This case questions the widely held dogma that older patients who undergo brachial plexus reconstruction do poorly. Given the short reinnervation distance and optimal donor nerve health, nerve transfers may be an excellent option for healthy older patients with traumatic brachial plexus palsy.
传统观念和现有文献表明，老年患者因创伤性臂丛神经麻痹进行神经重建后，预后较差。我们报告一例74岁男性患者，他在滑雪事故后因臂丛神经麻痹接受了多次神经移位重建手术。受伤16周后进行了肱三头肌至腋神经移位、副神经至肩胛上神经移位以及尺神经至肌皮神经移位。术后11年，患者外展可达65°，前屈肌力为M4，仅受疼痛性肩肱关节炎限制。肱二头肌和肱肌的肘关节屈曲均为M5-，肌肉体积和张力与对侧几乎对称。11年的电诊断研究表明，所有受影响肌肉均有神经再支配且运动单位募集改善。该病例对广泛持有的观点提出了质疑，即接受臂丛神经重建的老年患者预后不佳。鉴于神经再支配距离短且供体神经健康状况良好，对于健康的老年创伤性臂丛神经麻痹患者，神经移位可能是一个极佳的选择。
