肱肌转移术恢复臂丛神经麻痹患者手指屈曲功能的疗效
Outcomes of Muscle Brachialis Transfer to Restore Finger Flexion in Brachial Plexus Palsy.
作者信息
DeGeorge Brent R, Becker Hillary A, Faryna John H, Spinner Robert J, Bishop Allen T, Shin Alexander Y
机构信息
Rochester, Minn.
From the Department of Orthopedic Surgery, Division of Hand Surgery, and the Department of Neurosurgery, Mayo Clinic.
出版信息
Plast Reconstr Surg. 2017 Aug;140(2):307e-317e. doi: 10.1097/PRS.0000000000003563.
BACKGROUND
In adults with lower trunk brachial plexus injury, proximal nerve surgery for restoration of prehension demonstrates poor outcomes secondary to long distances required for nerve regeneration and time-dependent degradation of motor endplates. Options for reconstruction are limited to distal tendon or nerve transfers and free-functioning muscle transfers. In this article, the authors describe the long-term outcomes of brachialis muscle-to-flexor digitorum profundus transfer to restore prehension in patients with traumatic lower trunk brachial plexus injuries.
METHODS
Eighteen adult patients with lower trunk brachial plexus palsy underwent brachialis muscle-to-flexor digitorum profundus transfer with the goal of restoring rudimentary prehensile function at a single institution. The patients were followed throughout their recovery with functional outcomes and patient satisfaction ratings.
RESULTS
Brachialis muscle transfer resulted in restoring modified British Medical Research Council grade 3 or better function in 11 of 18 patients and grade 4 function in eight of 18 patients. Eleven of the 18 patients demonstrated a postoperative functional grasp for assistance with activities of daily living. Overall patient satisfaction following brachialis muscle transfer was 56 percent. Patient preoperative wrist extension (p < 0.018) and finger extension (p < 0.029) strength correlated with improved outcomes, whereas concomitant upper extremity fracture (p < 0.023) was associated with poorer outcomes.
CONCLUSIONS
Brachialis muscle transfer is an option for reconstruction of prehensile function in patients with lower trunk brachial plexus palsy with preserved wrist extension. Brachialis muscle transfer is particularly useful in patients who are poor candidates for microsurgical free-functioning muscle transfer for grasp; however, its functional outcomes are not universally successful.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
在成人下干臂丛神经损伤患者中，用于恢复抓握功能的近端神经手术因神经再生所需距离长以及运动终板的时间依赖性退化而效果不佳。重建选择仅限于远端肌腱或神经移位以及游离功能性肌肉移位。在本文中，作者描述了肱肌转位至指深屈肌以恢复创伤性下干臂丛神经损伤患者抓握功能的长期结果。
方法
18例成人下干臂丛神经麻痹患者在单一机构接受了肱肌转位至指深屈肌手术，目的是恢复基本的抓握功能。在患者整个恢复过程中对其功能结果和患者满意度进行随访。
结果
肱肌转位使18例患者中的11例恢复了改良英国医学研究委员会3级或更好的功能，18例患者中的8例恢复了4级功能。18例患者中有11例术后表现出功能性抓握，可辅助日常生活活动。肱肌转位后患者总体满意度为56%。患者术前腕背伸（p<0.018）和指背伸（p<0.029）力量与较好的结果相关，而合并上肢骨折（p<0.023）与较差的结果相关。
结论
肱肌转位是保留腕背伸功能的下干臂丛神经麻痹患者重建抓握功能的一种选择。肱肌转位在那些不适合进行显微游离功能性肌肉转位以实现抓握的患者中特别有用；然而，其功能结果并非普遍成功。
临床问题/证据级别：治疗性，IV级。
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