Zelenski Nicole A, Karzon Anthony L, Chang Tommy Nai-Jen, Chuang David Chwei-Chin, Lu Johnny Chuieng-Yi
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
J Reconstr Microsurg. 2023 Jun;39(5):361-366. doi: 10.1055/s-0042-1757750. Epub 2022 Oct 19.
Restoring elbow function is challenging after late presenting brachial plexus birth injury (BPBI). Free functioning muscle transplantation (FFMT) using the gracilis muscle is a reliable procedure to restore elbow flexion in patients with impaired function after spontaneous recovery or failed surgical reconstruction.
A retrospective review was performed on BPBI patients more than 2 years of age who received a FFMT between January 1993 and January 2018, with the aim of improving elbow flexion as the primary or secondary functional goal. Patients with preoperative elbow flexion Medical Research Council (MRC) grades less than 3 with more than or equal to 18 months of follow-up duration were included in the analysis. Patient demographic information and pre/postoperative clinical parameters including elbow flexion MRC scale, passive elbow range of motion, and complications were recorded. Surgical data including donor nerve choice, site of the FFMT tendon attachment, and necessity of concomitant procedures or reoperation were also analyzed.
Fifty-six FFMTs were performed for the primary (29 patients) or secondary (26 patients) objective of restoring elbow flexion. The mean age at the time of the procedure was 9.6 years (standard deviation [SD] = 6.29, = 3-35). Mean follow-up was 7.9 years (SD = 5.2). Elbow flexion improved from a median MRC grade 2 to 4 after a FFMT ( < 0.05). Patients who had a FFMT to restore two functions had 86% lower elbow flexion MRC grades than those who had a FFMT to restore flexion only ( < 0.05). Patients less than 12 years old at the time of surgery had more complications, reoperations, and rates of a flexion contracture more than or equal to 30 degrees than those aged more than 12 years ( < 0.05).
FFMT is a reliable option for upper extremity reanimation. Patients aged less than 12 years old at the time of FFMT had significantly more complications, reoperations, and rates of postoperative elbow flexion contracture more than or equal to 30 degrees, but equivalent elbow flexion MRC grades.
III.
对于迟发性臂丛神经产伤（BPBI）患者，恢复肘关节功能具有挑战性。使用股薄肌进行游离功能性肌肉移植（FFMT）是一种可靠的手术方法，可用于在自发恢复或手术重建失败后功能受损的患者中恢复肘关节屈曲功能。
对1993年1月至2018年1月期间接受FFMT的2岁以上BPBI患者进行回顾性研究，旨在将改善肘关节屈曲作为主要或次要功能目标。分析术前肘关节屈曲医学研究委员会（MRC）分级小于3级且随访时间不少于18个月的患者。记录患者的人口统计学信息以及术前/术后临床参数，包括肘关节屈曲MRC量表、肘关节被动活动范围和并发症。还分析了手术数据，包括供体神经选择、FFMT肌腱附着部位以及伴随手术或再次手术的必要性。
为恢复肘关节屈曲的主要（29例患者）或次要（26例患者）目标进行了56例FFMT手术。手术时的平均年龄为9.6岁（标准差[SD]=6.29，范围=3 - 35岁）。平均随访时间为7.9年（SD = 5.2）。FFMT术后肘关节屈曲从中位MRC 2级改善到4级（P<0.05）。接受FFMT以恢复两种功能的患者的肘关节屈曲MRC分级比仅接受FFMT以恢复屈曲功能的患者低86%（P<0.05）。手术时年龄小于12岁的患者比12岁以上的患者有更多并发症、再次手术以及屈曲挛缩≥30度的发生率（P<0.05）。
FFMT是上肢功能重建的可靠选择。FFMT时年龄小于12岁的患者有明显更多的并发症、再次手术以及术后肘关节屈曲挛缩≥30度的发生率，但肘关节屈曲MRC分级相当。
III级。
