Estrella Emmanuel P, Mina Josephine E, Montales Tristram D
Institute of Clinical Epidemiology, ASTRO Study Group, National Institutes of Health, University of the Philippines, Manila, Philippines.
Microsurgery Unit, Department of Orthopedics, Philippine General Hospital, University of the Philippines, Manila, Philippines.
J Hand Surg Glob Online. 2023 Mar 7;5(3):284-289. doi: 10.1016/j.jhsg.2023.01.012. eCollection 2023 May.
The objective of this study was to compare the outcomes of a single nerve transfer (SNT) with double nerve transfer (DNT) in the restoration of shoulder function in patients with upper (C5-6) or extended upper-type (C567) brachial plexus injuries.
A retrospective review of patients with C5-6 or C567 brachial plexus injuries operated on with nerve transfers from January 1, 2005, to December 31, 2017, was completed. The outcomes between SNT and DNT groups were evaluated with the Filipino Version of the Disabilities of the Arm, Shoulder, and Hand (FIL-DASH) scores, pain scores, muscle strength recovery, and range of motion. A subgroup analysis on surgical delay (< or ≥ 6 months), diagnosis (C5-6 or C567), and length of follow-up (< or ≥ 24 months) was also performed. All statistical significance was set at < .05.
A total of 22 patients with SNT and 29 with DNT were included in this study. There was no significant difference between the SNT and DNT groups as to postoperative FIL-DASH scores, pain, recovery of ≥M4, and range of motion for shoulder abduction and external rotation, although the absolute values for shoulder function were greater in the DNT than the SNT group. There was no significant difference between the SNT and DNT groups for surgical delay, diagnosis, and length of follow-up. A stronger recovery of ≥M4 for external rotation was observed in the DNT group compared to the SNT group if nerve transfer was performed in less than 6 months (86% vs 41%).
The outcomes for shoulder function between the 2 groups were similar, although the DNT group performed slightly better, especially with external rotation. Patients operated on less than 6 months from injury will benefit more from DNT for shoulder function, especially for external rotation.
Double nerve transfer may result in improved shoulder function.
本研究的目的是比较单神经移位术（SNT）与双神经移位术（DNT）在上肢（C5 - 6）或扩展型上肢型（C567）臂丛神经损伤患者恢复肩部功能方面的效果。
对2005年1月1日至2017年12月31日期间接受神经移位手术的C5 - 6或C567臂丛神经损伤患者进行回顾性研究。通过菲律宾版上肢、肩部和手部功能障碍量表（FIL - DASH）评分、疼痛评分、肌肉力量恢复情况以及活动范围，对SNT组和DNT组的结果进行评估。还对手术延迟时间（<或≥6个月）、诊断类型（C5 - 6或C567）以及随访时间（<或≥24个月）进行了亚组分析。所有统计学显著性设定为<0.05。
本研究共纳入22例接受SNT的患者和29例接受DNT的患者。SNT组和DNT组在术后FIL - DASH评分、疼痛、≥M4级别的恢复情况以及肩外展和外旋活动范围方面没有显著差异，尽管DNT组的肩部功能绝对值高于SNT组。SNT组和DNT组在手术延迟时间、诊断类型和随访时间方面没有显著差异。如果在受伤后不到6个月进行神经移位，DNT组在外旋方面≥M4级别的恢复比SNT组更强（86%对41%）。
两组之间的肩部功能结果相似，尽管DNT组表现略好，尤其是在外旋方面。受伤后不到6个月接受手术的患者将从DNT恢复肩部功能中获益更多，尤其是在外旋方面。
双神经移位术可能会改善肩部功能。
