Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Limb Lab, Rochester, Minnesota.
J Bone Joint Surg Am. 2022 Aug 17;104(16):1475-1482. doi: 10.2106/JBJS.21.01261. Epub 2022 Jun 22.
A cohort of patients with traumatic brachial plexus injuries (BPIs) underwent elective amputation following unsuccessful surgical reconstruction or delayed presentation. The results of amputation with and without a myoelectric prosthesis (MEP) using nonintuitive controls were compared. We sought to determine the benefits of amputation, and whether fitting with an MEP was feasible and functional.
We conducted a retrospective review of patients with BPI who underwent elective upper-extremity amputation at a single institution. Medical records were reviewed for demographics, injury and reconstruction details, amputation characteristics, outcomes, and complications. Prosthesis use and MEP function were assessed. The minimum follow-up for clinical outcomes was 12 months.
Thirty-two patients with BPI and an average follow-up of 53 months underwent elective amputation between June 2000 and June 2020. Among the cases were 18 transhumeral amputations, 12 transradial amputations, and 2 wrist disarticulations. There were 29 pan-plexus injuries, 1 partial C5-sparing pan-plexus injury, 1 lower-trunk with lateral cord injury, and 1 lower-trunk injury. Amputation occurred, on average, at 48.9 months following BPI and 36.5 months following final reconstruction. Ten patients were fitted for an MEP with electromyographic signal control from muscles not normally associated with the intended function (nonintuitive control). Average visual analog scale pain scores decreased post-amputation: from 4.8 pre-amputation to 3.3 for the MEP group and from 5.4 to 4.4 for the non-MEP group. Average scores on the Disabilities of the Arm, Shoulder and Hand questionnaire decreased post-amputation, but not significantly: from 35 to 30 for the MEP group and from 43 to 40 for the non-MEP group. Patients were more likely to be employed following amputation than they were before amputation. No patient expressed regret about undergoing amputation. All patients in the MEP group reported regular use of their prosthesis compared with 29% of patients with a traditional prosthesis. All patients in the MEP group demonstrated functional terminal grasp/release that they considered useful.
Amputation is an effective treatment for select patients with BPI for whom surgical reconstruction is unsuccessful. Patients who underwent amputation reported decreased mechanical pain, increased employment rates, and a high rate of satisfaction following surgery. In amputees with sufficient nonintuitive electromyographic signals, MEPs allow for terminal grasp/release and are associated with high rates of prosthesis use.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
一组创伤性臂丛神经损伤（BPIs）患者在不成功的手术重建或延迟出现后接受了选择性截肢。比较了使用非直观控制的有和没有肌电假体（MEP）的截肢结果。我们旨在确定截肢的益处，以及是否可以配备 MEP 并使其具有功能性。
我们对一家机构中接受选择性上肢截肢的 BPI 患者进行了回顾性研究。对人口统计学、损伤和重建细节、截肢特征、结果和并发症的医疗记录进行了回顾。评估了假体的使用和 MEP 的功能。临床结果的最低随访时间为 12 个月。
2000 年 6 月至 2020 年 6 月期间，32 名 BPI 患者接受了选择性截肢，平均随访时间为 53 个月。病例中有 18 例肱骨截肢，12 例桡骨截肢，2 例腕关节离断。有 29 例全臂丛神经损伤，1 例 C5 节段保留的全臂丛神经损伤，1 例下干伴外侧束损伤，1 例下干损伤。BPIs 后平均截肢时间为 48.9 个月，最后重建后平均截肢时间为 36.5 个月。10 名患者接受了 MEP 配型，使用来自非预期功能肌肉的肌电图信号控制（非直观控制）。截肢后平均视觉模拟量表疼痛评分降低：从截肢前的 4.8 分降至 MEP 组的 3.3 分和非 MEP 组的 4.4 分。截肢后平均手臂、肩部和手部残疾问卷评分降低，但无统计学意义：从 MEP 组的 35 分降至 30 分，从非 MEP 组的 43 分降至 40 分。截肢后患者比截肢前更有可能就业。没有患者对截肢表示后悔。MEP 组的所有患者均报告定期使用其假体，而传统假体组的患者为 29%。MEP 组的所有患者均表现出有用的功能性末端抓握/释放功能。
对于手术重建不成功的特定 BPI 患者，截肢是一种有效的治疗方法。接受截肢的患者报告机械疼痛减轻、就业率提高，并且术后满意度高。在具有足够非直观肌电图信号的截肢患者中，MEP 允许末端抓握/释放，并且与高假体使用率相关。
治疗性 III 级。有关证据水平的完整说明，请参阅作者指南。
