Karabeg Reuf
Private Surgical Clinic «Karabeg», Sarajevo, Bosnia and Herzegovina.
Med Arch. 2019 Dec;73(6):415-420. doi: 10.5455/medarh.2019.73.415-420.
Injuries to the radial nerve can occur at any point along its anatomical route, and the etiology quite varies. A particular entity are war injuries of the extremities, which have high morbidity but low mortality. After irreparable radial nerve injury, the only treatment is tendon transfer (if we neglect arthrodesis) with over then 40 methods. Four tendon transfers are considered as better than the other and two of them are the subject of our article flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU).
To evaluate the ultimate functional results of forearm tendon transfers for irreparable radial nerve damage caused by war injuries and indicate the better operative treatment choice in accordance with the evaluation schemes.
This retrospective research included 40 patients with isolated irreparable radial nerve damage. Patients were operated from 1993 to 1996. The follow-up period is from 3.5 to 11.5 years (until 2007). Twenty patients were operated using FCR tendon transfer method and twenty patients were operated using FCU tendon transfer method. The surgery was performed at the Clinic for Reconstructive and Plastic Surgery, Clinical Center University of Sarajevo. Three score evaluation schemes were used: Zachary, Neumann Pertecke and Tajima scheme, along with subjective evaluation of treatment.
Measured by the Zachary Evaluation Scheme, the overall score in patients undergoing FCR tendon transfer is 92.25%. In patients undergoing FCU tendon transfer, the total score was 82.20%. The total result of all 40 operated patients was 87.25%. The Zachary evaluation scheme showed a significant difference between FCR and FCU results by tendon transfer (p <0.05) in favor of the FCR tendon transfer. Tajima scheme proved a statistically significant difference between the two tendon transfers (p = 0.024), also in favor of FCR tendon transfers.
Forearm tendon transfer is a relevant method to compensate for the loss of function of the wrist, fingers and thumb extensions as a result of irreparable damage to the radial nerve. FCR tendon transfer provides better functional results than FCU tendon transfer in irreparable radial nerve damage. The time elapsed from the injury to the performed surgery of the tendon transfer has no effect on the final functional result. There is no surgical tendon transfer procedure that can be recommended as a standard for any patient. Practically, the surgeon must tailor the surgery to the patient's needs. It is necessary to develop a unique and generally accepted evaluation scheme for the results of tendon transfers that will enable comparisons of results achieved. Both methods can be used for irreparable damage of radial nerve due to any etiology.
桡神经损伤可发生于其解剖走行的任何部位，病因差异很大。四肢战伤是一种特殊情况，其发病率高但死亡率低。在桡神经遭受不可修复的损伤后，唯一的治疗方法是肌腱转位术（若不考虑关节固定术），有40多种方法。有四种肌腱转位术被认为比其他方法更好，其中两种是本文的主题，即桡侧腕屈肌（FCR）和尺侧腕屈肌（FCU）。
评估因战伤导致桡神经不可修复损伤而行前臂肌腱转位术的最终功能结果，并根据评估方案指出更好的手术治疗选择。
这项回顾性研究纳入了40例孤立性桡神经不可修复损伤患者。患者于1993年至1996年接受手术。随访期为3.5至11.5年（截至2007年）。20例患者采用FCR肌腱转位术，20例患者采用FCU肌腱转位术。手术在萨拉热窝大学临床中心重建与整形诊所进行。使用了三种评分评估方案：扎卡里（Zachary）、诺伊曼·佩特克（Neumann Pertecke）和田岛（Tajima）方案，以及对治疗的主观评估。
根据扎卡里评估方案测量，接受FCR肌腱转位术患者的总体评分为92.25%。接受FCU肌腱转位术的患者，总分是82.20%。所有40例手术患者的总结果为87.25%。扎卡里评估方案显示，FCR和FCU肌腱转位术的结果存在显著差异（p<0.05），FCR肌腱转位术更具优势。田岛方案也证明两种肌腱转位术之间存在统计学显著差异（p = 0.024），同样支持FCR肌腱转位术。
前臂肌腱转位术是一种用于补偿因桡神经不可修复损伤导致的腕部、手指和拇指伸展功能丧失的相关方法。在桡神经不可修复损伤中，FCR肌腱转位术比FCU肌腱转位术能提供更好的功能结果。从损伤到进行肌腱转位术的时间间隔对最终功能结果没有影响。没有一种手术肌腱转位程序可以被推荐为适用于任何患者的标准。实际上，外科医生必须根据患者的需求定制手术。有必要制定一种独特且被普遍接受的肌腱转位术结果评估方案，以便能够比较所取得的结果。两种方法均可用于因任何病因导致的桡神经不可修复损伤。
