三头肌长头运动支神经转位至腋神经后的发病率：转位后肱三头肌肌力的回顾性主观和客观评估。
Morbidity of long head of the triceps motor branch neurotization to the axillary nerve: Retrospective subjective and objective assessment of triceps brachii strength after transfer.
机构信息
Département de Chirurgie Orthopédique, Unité de Chirurgie de la Main et du Membre Supérieur, Chirurgie des Nerfs Périphériques, CHU Montpellier, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
Département de Chirurgie Orthopédique, Unité de Chirurgie de la Main et du Membre Supérieur, Chirurgie des Nerfs Périphériques, CHU Montpellier, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
出版信息
Orthop Traumatol Surg Res. 2022 Sep;108(5):103280. doi: 10.1016/j.otsr.2022.103280. Epub 2022 Apr 25.
INTRODUCTION
Morbidity is considered to be negligible in Leechavengvongs transfer (LT) of the long head of the triceps onto the axillary nerve, but the assessment methods used may lack reproducibility. We assessed triceps strength after LT objectively by the isokinetic technique, addressing the following questions: Is strength lowered after LT compared to the healthy limb? And 2) is there a good correlation between isokinetic dynamometry and subjective assessment?
HYPOTHESIS
Isokinetic measurement shows a decrease in triceps strength at peak torque after LT compared to the healthy limb, and this morbidity is underestimated on subjective assessment.
MATERIAL AND METHODS
This single-center retrospective study included patients undergoing LT for axillary nerve trunk palsy between 2008 and 2020, with M5 triceps preoperatively on the British Medical Research Council (BMRC) scale. Twenty patients, with a mean age of 25±9years (range, 15-48years) were assessed at a mean 58±47months (range, 6-174months). Elbow extension strength was assessed on a standardized questionnaire, BMRC isometric test and isokinetic test on an angular course of 90° at 60°/sec and 180°/sec concentrically and 30°/sec excentrically.
RESULTS
Strength at 60°/sec and 180°/sec concentrically and 30°/sec excentrically was significantly lower than in the healthy limb: respectively, -17Nm, -15Nm, and -16Nm, (p<0.001) for a mean -23%. Loss of strength was mainly severe on isokinetic testing and mild on isometric testing. Seven patients reported contracture (35%), 12 fatigue (60%), and 3 weakness (15%). Satisfaction with extension strength was excellent or good for respectively 12 (60%) and 8 patients (40%). Triceps strength was graded BMRC M4 in 9 triceps (11%) and M5 in 11 (55%).
DISCUSSION
After LT, isokinetic measurement found generally severe loss of triceps strength, but without subjective impact on everyday life.
LEVEL OF EVIDENCE
IV; retrospective study.
简介
Leechavengvongs 转移（LT）将肱三头肌长头转移到腋神经上，其发病率被认为可以忽略不计，但所使用的评估方法可能缺乏可重复性。我们通过等速技术客观地评估 LT 后的肱三头肌力量，旨在回答以下问题：与健康肢体相比，LT 后肱三头肌力量是否降低？2）等速测力法与主观评估之间是否存在良好的相关性？
假设
与健康肢体相比，LT 后等速测量显示肱三头肌在峰值扭矩时的力量下降，而这种发病率在主观评估中被低估。
材料和方法
这项单中心回顾性研究纳入了 2008 年至 2020 年间因腋神经干麻痹而行 LT 的患者，术前肱三头肌按英国医学研究理事会（BMRC）分级为 M5。20 例患者，平均年龄 25±9 岁（范围 15-48 岁），平均随访 58±47 个月（范围 6-174 个月）。使用标准化问卷、BMRC 等长测试和等速测试评估伸肘力量，角速度为 90°，测试速度为 60°/秒、180°/秒和 30°/秒。
结果
60°/秒、180°/秒的同心运动和 30°/秒的偏心运动的力量明显低于健康肢体：分别为-17Nm、-15Nm 和-16Nm，（p<0.001），平均下降了 23%。力量损失主要在等速测试中严重，而在等长测试中则较轻。7 例患者报告有挛缩（35%），12 例疲劳（60%），3 例乏力（15%）。12 例（60%）和 8 例（40%）患者对伸肌力量的满意度为优秀或良好。9 例（11%）肱三头肌按 BMRC M4 分级，11 例（55%）按 M5 分级。
讨论
LT 后，等速测量发现肱三头肌普遍严重无力，但对日常生活无主观影响。
证据水平
IV；回顾性研究。
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