Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Reconstr Microsurg. 2021 Nov;37(9):713-719. doi: 10.1055/s-0041-1726030. Epub 2021 May 13.
There is a paucity of research investigating the impact of patient comorbidities, such as obesity and smoking, on nerve transfer outcomes. The objective of this retrospective cohort study was to evaluate the impact of body mass index (BMI) and comorbidities on the clinical outcomes of upper extremity nerve transfers.
A retrospective cohort study was executed. Patients were eligible for inclusion if they had an upper extremity nerve transfer with a minimum of 12-months follow-up. Data was collected regarding demographics, comorbidities, injury etiology, nerve transfer, as well as preoperative and postoperative clinical assessments. The primary outcome measure was strength of the recipient nerve innervated musculature. Statistical analysis used the Mann-Whitney U test, Wilcoxon signed-rank test, and Spearman's rho.
Thirty-eight patients undergoing 43 nerve transfers were eligible for inclusion. Patients had a mean age of 48.8 years and a mean BMI of 27.4 kg/m (range:19.7-39.0). Injuries involved the brachial plexus (32%) or its terminal branches (68%) with the most common etiologies including trauma (50%) and compression (26%). Anterior interosseous nerve to ulnar motor nerve (35%) was the most common transfer performed. With a mean follow-up of 20.1 months, increased BMI (= 0.036) and smoking (= 0.021) were associated with worse postoperative strength.
This retrospective cohort study demonstrated that increased BMI and smoking may be associated with worse outcomes in upper extremity nerve transfers-review of the literature yields ambiguity in both regards. To facilitate appropriate patient selection and guide expectations regarding prognosis, further experimental and clinical work is warranted.
目前，研究肥胖和吸烟等患者合并症对上肢神经转移结果影响的文献较少。本回顾性队列研究的目的是评估体重指数（BMI）和合并症对上肢神经转移临床结果的影响。
进行回顾性队列研究。如果患者上肢神经转移后有至少 12 个月的随访，则符合纳入标准。收集的数据包括人口统计学、合并症、损伤病因、神经转移以及术前和术后临床评估。主要结局指标为受神经支配肌肉的力量。统计分析使用 Mann-Whitney U 检验、Wilcoxon 符号秩检验和 Spearman's rho。
38 例接受 43 次神经转移的患者符合纳入标准。患者的平均年龄为 48.8 岁，平均 BMI 为 27.4kg/m（范围：19.7-39.0）。损伤涉及臂丛（32%）或其终末支（68%），最常见的病因包括创伤（50%）和压迫（26%）。前骨间神经到尺神经运动支（35%）是最常见的转移方式。平均随访 20.1 个月后，BMI 增加（=0.036）和吸烟（=0.021）与术后力量减弱相关。
本回顾性队列研究表明，BMI 增加和吸烟可能与上肢神经转移的结果较差有关，但文献在这两方面存在矛盾。为了便于适当的患者选择和指导预后的预期，需要进一步进行实验和临床工作。
