Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Oper Neurosurg (Hagerstown). 2021 Jun 15;21(1):20-26. doi: 10.1093/ons/opab057.
Acute flaccid myelitis (AFM) is an acute-onset anterior horn disease resulting in flaccid paralysis of extremities, trunk, facial, and cervical musculature in children following upper respiratory or gastrointestinal viral illness. Nerve transfer procedures have been shown to restore function.
To present a technical description of sciatic-to-femoral nerve transfers in 4 children with AFM.
Retrospective review of relevant cases was performed.
A total of 4 cases are presented of young children with persistent quadriparesis in the setting of AFM, presenting between 4 and 15 mo following initial diagnosis. Electromyography showed denervation of muscles innervated by the femoral nerve, with sparing of the sciatic distribution. The obturator nerve was also denervated in all patients. We therefore elected to pursue sciatic-to-femoral transfers to restore active knee extension. These transfers involved end-to-end coaptation of a sciatic nerve fascicle to the femoral nerve motor branches supplying quadriceps muscles.
We present technical descriptions of bilateral sciatic-to-femoral nerve neurotization for the restoration of quadriceps function in 4 patients with AFM. The sciatic nerve fascicles are a reasonable alternative donor nerve for patients with proximal muscle paralysis and limited donor options in the lower extremity.
急性弛缓性脊髓炎（AFM）是一种急性发作的前角疾病，可导致上呼吸道或胃肠道病毒感染后儿童的四肢、躯干、面部和颈部肌肉瘫痪。神经转移术已被证明可恢复功能。
介绍 4 例 AFM 患者行坐骨神经-股神经转移术的技术描述。
对相关病例进行回顾性研究。
共介绍了 4 例年轻儿童的病例，这些儿童在 AFM 发病后 4 至 15 个月持续出现四肢瘫痪，肌电图显示股神经支配的肌肉失神经支配，而坐骨神经支配的肌肉不受影响。所有患者的闭孔神经也失神经支配。因此，我们选择进行坐骨神经-股神经转移术以恢复主动伸膝功能。这些转移术涉及坐骨神经束与股神经运动支的端端吻合，股神经运动支供应股四头肌。
我们介绍了 4 例 AFM 患者双侧坐骨神经-股神经神经再支配以恢复股四头肌功能的技术描述。对于近端肌肉瘫痪且下肢供体选择有限的患者，坐骨神经束是一种合理的替代供体神经。
