From the Keck School of Medicine, University of Southern California; and the Children's Hospital Los Angeles.
Plast Reconstr Surg. 2021 Mar 1;147(3):645-655. doi: 10.1097/PRS.0000000000007583.
Clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis are unknown.
A single-institution retrospective case series was analyzed to describe clinical features of acute flaccid myelitis diagnosed between October of 2013 and December of 2016. Patients were consecutively sampled children with a diagnosis of acute flaccid myelitis who were referred to a hand surgeon. Patient factors and initial severity of paralysis were compared with upper extremity muscle strength outcomes using the Medical Research Council scale every 3 months up to 18 months after onset.
Twenty-two patients with acute flaccid myelitis (aged 2 to 16 years) were studied. Proximal upper extremity musculature was more frequently and severely affected, with 56 percent of patients affected bilaterally. Functional recovery of all muscle groups (≥M3) in an individual limb was observed in 43 percent of upper extremities within 3 months. Additional complete limb recovery to greater than or equal to M3 after 3 months was rarely observed. Extraplexal paralysis, including spinal accessory (72 percent), glossopharyngeal/hypoglossal (28 percent), lower extremity (28 percent), facial (22 percent), and phrenic nerves (17 percent), was correlated with greater severity of upper extremity paralysis and decreased spontaneous recovery. There was no correlation between severity of paralysis or recovery and patient characteristics, including age, sex, comorbidities, prodromal symptoms, or time to paralysis.
Spontaneous functional limb recovery, if present, occurred early, within 3 months of the onset of paralysis. The authors recommend that patients without signs of early recovery warrant consideration for early surgical intervention and referral to a hand surgeon or other specialist in peripheral nerve injury.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
急性弛缓性脊髓炎（acute flaccid myelitis，AFM）患者不经手术上肢功能恢复的临床特征和时间尚不清楚。
对 2013 年 10 月至 2016 年 12 月期间诊断为急性弛缓性脊髓炎的患者进行了单机构回顾性病例系列分析。连续取样的患者为手部外科医生转诊的急性弛缓性脊髓炎诊断患儿。使用医学研究委员会（Medical Research Council，MRC）量表，每 3 个月评估一次患者因素和发病后最初瘫痪严重程度，直至发病后 18 个月，以比较上肢肌力恢复结果。
22 例急性弛缓性脊髓炎（年龄 2 至 16 岁）患者参与研究。近端上肢肌肉更常且更严重地受累，56%的患者双侧受累。3 个月内，43%的上肢各肌群（≥M3）出现功能恢复。3 个月后，很少观察到完全肢体恢复至≥M3。包括副神经（72%）、舌咽神经/舌下神经（28%）、下肢（28%）、面部（22%）和膈神经（17%）在内的外展神经瘫痪与上肢瘫痪严重程度增加和自发性恢复减少相关。瘫痪严重程度或恢复情况与患者特征（年龄、性别、合并症、前驱症状或瘫痪时间）无相关性。
如果存在自发的肢体功能恢复，通常在发病后 3 个月内出现。作者建议，无早期恢复迹象的患者应考虑早期手术干预，并转介至手部外科医生或周围神经损伤专家。
临床问题/证据水平：风险，III。
