Alrabai Hamza M, Gesheff Martin G, Hammouda Ahmed I, Conway Janet D
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; Department of Orthopedics, King Saud University, Riyadh, Saudi Arabia.
International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
J Hand Surg Am. 2018 Sep;43(9):872.e1-872.e6. doi: 10.1016/j.jhsa.2018.02.005. Epub 2018 Apr 9.
Voluntary elbow extension is essential for optimal upper limb positioning required for daily living activities, particularly above-shoulder maneuvers. The authors present a case of traumatic brachial plexus injury in which paralysis of the musculature selectively supplied by the posterior cord was based on magnetic resonance imaging and nerve conduction studies. An attempt at a radial nerve graft at another center was not effective. Ipsilateral hand function improved after multiple local tendon transfers were performed. Restoration of active elbow extension was not possible using the posterior deltoid or the latissimus dorsi because they were denervated by the primary trauma and so the trapezius muscle was used as a donor muscle unit to restore voluntary elbow extension. The patient resumed biking 6 weeks after the transfer procedure. At 2-year follow-up, full active elbow extension was regained, elbow extension power scored 4 of 5, and the patient reported that he could ride his bicycle for 70 miles.
主动伸肘对于日常生活活动所需的最佳上肢姿势至关重要，尤其是肩部以上的动作。作者报告了一例创伤性臂丛神经损伤病例，根据磁共振成像和神经传导研究，由后束选择性支配的肌肉组织出现麻痹。在另一个中心进行的桡神经移植尝试未取得成效。在进行多次局部肌腱转位术后，同侧手部功能得到改善。由于三角肌后部和背阔肌因原发性创伤而失神经支配，因此无法利用它们恢复主动伸肘功能，于是使用斜方肌作为供体肌肉单位来恢复主动伸肘功能。转位手术后6周，患者恢复了骑自行车活动。在2年的随访中，患者重新获得了完全主动伸肘功能，伸肘力量评分为5分中的4分，患者报告称他能够骑行70英里。
