神经重建与游离功能肌移植治疗晚期创伤性臂丛神经麻痹后肘关节功能恢复的系统评价
Recovery of Elbow Flexion after Nerve Reconstruction versus Free Functional Muscle Transfer for Late, Traumatic Brachial Plexus Palsy: A Systematic Review.
机构信息
Los Angeles, Calif.
From the Division of Plastic and Maxillofacial Surgery, University of Southern California Keck School of Medicine, Children's Hospital Los Angeles.
出版信息
Plast Reconstr Surg. 2018 Apr;141(4):949-959. doi: 10.1097/PRS.0000000000004229.
BACKGROUND
In late presentation of brachial plexus trauma, it is unclear whether donor nerves should be devoted to nerve reconstruction or reserved for free functional muscle transfer. The authors systematically reviewed recovery of elbow flexion after nerve reconstruction versus free functional muscle transfer for late, traumatic brachial plexus palsy.
METHODS
A systematic review was performed using the PubMed, Embase, and Cochrane databases to identify all cases of traumatic brachial plexus palsy in patients aged 18 years or older. Patients who underwent late (≥12 months) nerve reconstruction or free functional muscle transfer for elbow flexion were included. Age, time to operation, and level of brachial plexus injury were recorded. British Medical Research Council grade for strength and range of motion were evaluated for elbow flexion.
RESULTS
Thirty-three studies met criteria, for a total of 103 patients (nerve reconstruction, n = 53; free functional muscle transfer, n = 50). There were no differences across groups regarding surgical age (time from injury) and preoperative elbow flexion. For upper trunk injuries, 53 percent of reconstruction patients versus 100 percent of muscle transfer patients achieved grade M3 or greater strength, and 43 percent of reconstruction patients versus 70 percent of muscle transfer patients achieved grade M4 or greater strength. Of the total brachial plexus injuries, 37 percent of reconstruction patients versus 78 percent of muscle transfer patients achieved grade M3 or greater strength, and 16 percent of reconstruction patients versus 46 percent of muscle transfer patients achieved grades M4 or greater strength.
CONCLUSION
In late presentation of traumatic brachial plexus injuries, donor nerves should be reserved for free functional muscle transfer to restore elbow flexion.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
在臂丛神经损伤的晚期表现中，尚不清楚供体神经应该用于神经重建还是保留用于游离功能性肌肉转移。作者系统地回顾了神经重建与游离功能性肌肉转移治疗晚期创伤性臂丛神经病后肘部屈曲的恢复情况。
方法
使用 PubMed、Embase 和 Cochrane 数据库进行系统评价，以确定所有 18 岁或以上的创伤性臂丛神经病患者的病例。纳入接受晚期（≥12 个月）神经重建或游离功能性肌肉转移以恢复肘部屈曲的患者。记录患者年龄、手术时间和臂丛神经损伤水平。评估肘部屈曲的英国医学研究理事会（British Medical Research Council，MRC）肌力分级和活动范围。
结果
33 项研究符合标准，共纳入 103 例患者（神经重建组 53 例，游离功能性肌肉转移组 50 例）。两组在手术年龄（受伤后时间）和术前肘部屈曲方面无差异。对于上干损伤，53%的重建患者与 100%的肌肉转移患者获得 M3 或更高的肌力，43%的重建患者与 70%的肌肉转移患者获得 M4 或更高的肌力。对于整个臂丛神经损伤，37%的重建患者与 78%的肌肉转移患者获得 M3 或更高的肌力，16%的重建患者与 46%的肌肉转移患者获得 M4 或更高的肌力。
结论
在创伤性臂丛神经损伤的晚期表现中，供体神经应保留用于游离功能性肌肉转移，以恢复肘部屈曲。
临床问题/证据水平：治疗性，IV。
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