Hand Surgery and Microsurgery Group, Faculdade de Medicina do ABC, Santo Ándre, Brazil.
Hand Surgery and Reconstructive Microsurgery Group, Hospital das Clínicas da Faculdade de Medicina, University of São Paulo, Brazil.
Hand (N Y). 2022 Mar;17(2):214-218. doi: 10.1177/1558944720918325. Epub 2020 Jun 2.
Oberlin et al presented a new technique for nerve transfer that completely changed the prognosis of patients with brachial plexus injury. Currently, most of the literature addresses cases submitted to early surgical intervention, before 12 months from injury, showing consistent good results. The aim of this study was to evaluate the feasibility of the Oberlin procedure in late presentation cases (≥12 months), comparing the elbow flexion strength with patients operated earlier. We retrospectively reviewed 49 patients with partial brachial plexus injuries submitted to the Oberlin procedure. They were divided into 2 groups. Group A included 39 patients operated with <12 months of injury. The mean postoperative follow-up was 22.53 months. The interval from injury to surgery varied from 4 to 11 months (±8.45 months). Group B included 10 patients with surgery ≥12 months after injury. The mean postoperative follow-up was 32 months. The interval from injury to surgery ranged from 12 to 19 months (±15.4 months). Patients were evaluated monthly after surgery and the elbow flexion strength was measured using the British Medical Research Council scale. In Group A, 24 patients presented with either good (M3) or excellent (M4) elbow flexion strength. In Group B, 9 patients presented with either good (M3) or excellent (M4) elbow flexion strength. A significant difference was not seen in the postoperative elbow flexion strength among the 2 groups. Biceps reinnervation with the Oberlin procedure is still feasible and should be attempted after more than 12 months of injury in partial brachial plexus injuries.
奥伯林等人提出了一种新的神经转移技术，彻底改变了臂丛神经损伤患者的预后。目前，大多数文献都涉及到在损伤后 12 个月内接受早期手术干预的病例，这些病例显示出一致的良好结果。本研究旨在评估奥伯林手术在晚期（≥12 个月）病例中的可行性，比较其与早期手术患者的肘屈肌力量。我们回顾性分析了 49 例接受奥伯林手术的部分臂丛神经损伤患者。他们被分为 2 组。A 组包括 39 例<12 个月损伤的患者。术后平均随访时间为 22.53 个月。从损伤到手术的时间间隔为 4 至 11 个月（±8.45 个月）。B 组包括 10 例损伤后≥12 个月手术的患者。术后平均随访时间为 32 个月。从损伤到手术的时间间隔为 12 至 19 个月（±15.4 个月）。术后每月对患者进行评估，并使用英国医学研究理事会量表测量肘屈肌力量。A 组 24 例患者的肘屈肌力量为良好（M3）或优秀（M4）。B 组 9 例患者的肘屈肌力量为良好（M3）或优秀（M4）。2 组术后肘屈肌力量无显著差异。奥伯林术式的二头肌再神经支配仍然可行，在部分臂丛神经损伤后 12 个月以上应尝试进行。
