Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung Medica University, Taoyuan, Taiwan.
Department of Medical Imaging and Intervention, Chang Gung Memorial, Hospital at Keelung, Chang Gung University, Taoyuan, Taiwan.
J Reconstr Microsurg. 2023 May;39(4):272-278. doi: 10.1055/s-0041-1736320. Epub 2021 Oct 19.
Loss of elbow flexion is a common sequela of acute brachial plexus injuries (BPIs). The Mackinnon/Oberlin-II double fascicular transfer (DFT) is a widely used method to restore this function in acute C5-6 or C5-7 injuries. This study attempted to evaluate if this technique can be applied reliably for cases involving C8 and/or T1 injuries.
Adult patients with acute BPIs who underwent the Mackinnon/Oberlin-II DFT in our center between 2008 and 2018 were retrospectively identified. Group I ( = 37) included patients with only C5-6 or C5-7 injury, while group II ( = 32) patients presented C5-8 ± T1 injuries. The demographic data, pre- and postoperative neurologic evaluations, electrodiagnostic studies, and grip strength assessment were collected.
A total of 69 patients met the inclusion criteria. Preoperatively, the patients in group II presented poorer nerve conduction and electromyography in both the median and the ulnar nerves and the supply muscles. The percentage of M3 achievement in both groups was 91.9 versus 87.5% and M4 was 73.0 and 71.9%, respectively, which both were not statically significant but the achievement of group II was slower than the group I, 1 to 2 months slower, respectively. Both groups had 57.57 and 46.0% of the postoperative grip power compared with the healthy side, the result of shoulder abduction was not different ( = 0.480).
With careful preoperative evaluation, early intervention, appropriate intraoperative functional fascicle selection, and aggressive postoperative rehabilitation, indications for the Mackinnon/Oberlin-II DFT technique can safely include acute C5-8 injuries and even partial T1 acute BPIs.
肘部伸展丧失是急性臂丛神经损伤（BPIs）的常见后遗症。麦金农/奥伯林-II 双束转移（DFT）是一种广泛用于恢复 C5-6 或 C5-7 损伤功能的方法。本研究试图评估该技术是否可可靠应用于涉及 C8 和/或 T1 损伤的病例。
回顾性分析 2008 年至 2018 年期间在我院行麦金农/奥伯林-II DFT 的急性 BPIs 成年患者。I 组（n=37）包括仅有 C5-6 或 C5-7 损伤的患者，而 II 组（n=32）患者存在 C5-8±T1 损伤。收集了患者的人口统计学数据、术前和术后神经评估、电诊断研究和握力评估结果。
共有 69 例患者符合纳入标准。术前，II 组患者正中神经和尺神经及其供应肌肉的神经传导和肌电图均较差。两组的 M3 实现率分别为 91.9%和 87.5%，M4 分别为 73.0%和 71.9%，均无统计学差异，但 II 组的实现速度较慢，分别慢 1 至 2 个月。两组术后握力分别为健侧的 57.57%和 46.0%，肩外展结果无差异（P=0.480）。
通过仔细的术前评估、早期干预、术中适当选择功能束、积极的术后康复，麦金农/奥伯林-II DFT 技术的适应证可安全包括急性 C5-8 损伤，甚至部分急性 T1 BPIs。
