Liu Yuzhou, Zhuang Yongqing, Yu Hu, Xiong Hongtao, Lao Jie
Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Jing An District, Shanghai 200040, People's Republic of China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, People's Republic of China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.
Hand and Microvascular Surgery Department, Shenzhen People's Hospital, Shenzhen 518020, Guangdong Province, China.
J Plast Reconstr Aesthet Surg. 2018 Sep;71(9):1245-1251. doi: 10.1016/j.bjps.2018.05.024. Epub 2018 Jun 8.
The widely used nerve transfer sources for elbow flexion in patients with upper brachial plexus avulsion (UBPA) include partial ulnar nerve, phrenic nerve, and intercostal nerves. A retrospective review of 21 patients treated with phrenic and partial ulnar nerve transfers for elbow flexion after UBPA was carried out. In the phrenic nerve transfer group, the phrenic nerve was transferred to the anterolateral bundle of the anterior division of the upper trunk; in the partial ulnar nerve transfer group, one fascicle of the ulnar nerve was transferred to the biceps branch. The British Medical Research Council (MRC) grading system, angle of elbow flexion, electromyography (EMG), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scoring were used to evaluate the recovery of elbow flexion at least 3 years postoperatively. The efficiency of motor function in phrenic nerve transfer group was 82%, whereas it was 80% in partial ulnar nerve transfer group. The outstanding rates of angle of elbow flexion were 64% and 70% in phrenic and partial ulnar nerve transfer groups, respectively. The DASH scores after surgery were significantly lower than those before surgery in the two groups. There was no statistical difference between the two groups in the changes of DASH scores before and after surgery. Both of phrenic and partial ulnar nerve transfers had good prognosis for elbow flexion in patients with UBPA.
在上臂丛神经撕脱伤（UBPA）患者中，广泛用于屈肘的神经移位来源包括部分尺神经、膈神经和肋间神经。对21例接受膈神经和部分尺神经移位术治疗UBPA后屈肘功能的患者进行了回顾性研究。在膈神经移位组中，膈神经移位至上干前支的前外侧束；在部分尺神经移位组中，将尺神经的一束移位至肱二头肌支。采用英国医学研究委员会（MRC）分级系统、屈肘角度、肌电图（EMG）以及手臂、肩部和手部功能障碍（DASH）问卷评分来评估术后至少3年屈肘功能的恢复情况。膈神经移位组的运动功能有效率为82%，而部分尺神经移位组为80%。膈神经和部分尺神经移位组的屈肘角度优良率分别为64%和70%。两组术后的DASH评分均显著低于术前。两组术前和术后DASH评分的变化无统计学差异。膈神经和部分尺神经移位术对UBPA患者的屈肘功能均有良好的预后。
