Segal David, Cornwall Roger, Little Kevin J
Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, affiliated with Cincinnati University, Cincinnati, OH; Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, affiliated with Tel Aviv University, Tel Aviv, Israel.
Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, affiliated with Cincinnati University, Cincinnati, OH.
J Hand Surg Am. 2019 Jul;44(7):578-587. doi: 10.1016/j.jhsa.2019.02.004. Epub 2019 Mar 18.
The results of a spinal accessory nerve-to-suprascapular (SAN-SSN) nerve transfer for brachial plexus birth injuries (BPBIs) have thus far been presented only in limited case series. Our study evaluates the recovery of shoulder function of patients who underwent an SAN-SSN for BPBI as an isolated procedure or as part of a multinerve reconstruction (MNR) surgery.
We retrospectively reviewed the medical records of patients at a single institution who underwent an SAN-SSN after BPBI. Inclusion criteria were patients with both preoperative and a minimum 12-months postoperative active movement scale (AMS) scores. Patients for whom the primary surgery involved tendon transfers were excluded. The primary outcome measures were AMS scores for shoulder abduction, forward flexion, and external rotation and secondary outcomes included the need for further shoulder surgery to improve function.
Seventy-three patients met the inclusion criteria. Forty-three patients (58.9%) obtained functional shoulder motion (AMS ≥ 6) of at least 1 of 3 planes (abduction/flexion/external rotation) following surgery, with 13 patients (17.8%) achieving full recovery of 1 of these shoulder motions against gravity (AMS = 7). Fifty-six patients (76.7%) did not undergo subsequent tendon transfers or corrective osteotomies to augment shoulder function. The MNR procedures were performed in 46 patients (63%), of whom 45.7% gained a functional recovery. In 27 patients for whom SAN-SSN nerve transfer was conducted in isolation, 81.5% gained functional shoulder motion. However, isolated SAN-SSNs were conducted at a later age than MNR procedures (13.2 vs 4.8 months) and had higher preoperative AMS scores. The anterior and posterior approaches for SAN-SSN were both found to be effective when used for SAN-SSN in BPBI. When the follow-up duration cutoff was set to 3 years, the outcomes were found to be superior.
In 76.7% of the patients, SAN-SSN was able to recover function that was sufficient to prevent tendon transfers and corrective osteotomies. A cutoff of 3 postoperative years should be used as a benchmark for analyzing the results of this procedure.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
臂丛神经产伤（BPBI）的副神经至肩胛上神经（SAN-SSN）神经移位术的结果目前仅在有限的病例系列中有所报道。我们的研究评估了接受SAN-SSN神经移位术治疗BPBI的患者，该手术作为单独手术或作为多神经重建（MNR）手术的一部分，其肩部功能的恢复情况。
我们回顾性分析了一家机构中接受BPBI后进行SAN-SSN神经移位术的患者的病历。纳入标准为术前及术后至少12个月有主动运动量表（AMS）评分的患者。主要手术涉及肌腱转移的患者被排除。主要结局指标为肩部外展、前屈和外旋的AMS评分，次要结局包括是否需要进一步的肩部手术以改善功能。
73例患者符合纳入标准。43例患者（58.9%）术后在3个平面（外展/前屈/外旋）中的至少1个平面获得了功能性肩部运动（AMS≥6），其中13例患者（17.8%）在抗重力情况下实现了这些肩部运动中的1项完全恢复（AMS=7）。56例患者（76.7%）未进行后续的肌腱转移或截骨矫正术来增强肩部功能。MNR手术在46例患者（63%）中进行，其中45.7%获得了功能恢复。在27例单独进行SAN-SSN神经移位术的患者中，81.5%获得了功能性肩部运动。然而，单独进行SAN-SSN神经移位术的年龄比MNR手术晚（13.2个月对4.8个月），且术前AMS评分更高。SAN-SSN的前路和后路用于BPBI的SAN-SSN时均被发现是有效的。当随访时间截止设定为3年时，结果更佳。
在76.7%的患者中，SAN-SSN能够恢复足以避免肌腱转移和截骨矫正术的功能。术后3年应作为分析该手术结果的基准。
研究类型/证据水平：治疗性IV级。
