Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore.
J Hand Surg Am. 2024 Jun;49(6):526-531. doi: 10.1016/j.jhsa.2024.01.013. Epub 2024 Mar 2.
Pan-brachial plexus injury patients present a reconstructive challenge. The root analysis score, developed from parsimonious multivariable modeling of 311 pan-brachial plexus injury patients, determines the probability of having a viable C5 nerve based on four categories: positive C5 Tinel test, intact C5 nerve on computed tomography myelogram, lack of hemidiaphragmatic elevation, and absence of midcervical paraspinal fibrillations.
Root analysis scores were calculated for a separate cohort of patients with pan-brachial plexus injuries. Scores were validated by the presence or absence of a graftable C5 root, based on supraclavicular exploration and intraoperative electrophysiologic testing. Receiver operating characteristic curve, accuracy, and concordance statistic of the scores were calculated. Patients were divided into three root analysis score cohorts: less than 50 (low), 50-75 (average), and 75-100 points (high) based on dividing the score into quartiles and combining the lowest two. The probability, sensitivity, and specificity of each cohort having an available C5 nerve were based on the intraoperative assessment.
Eighty patients (mean age, 33.1 years; 15 women and 65 men) were included. Thirty-one patients (39%) had a viable C5 nerve. The root analysis calculator had an overall accuracy of 82.5%, a receiver operating characteristic of 0.87, and a concordance statistic of 0.87, demonstrating high overall predictive value; 6.5% of patients with a score of less than 50 (94% sensitivity and 43% specificity), 16.1% of patients with a score of 50-75 (94% sensitivity and 67% specificity), and 77.4% of patients with a score of 75-100 (77% sensitivity and 90% specificity) had a graftable C5 nerve.
The root analysis score demonstrated high accuracy and predictive power for a viable C5 nerve. In patients with a score of less than 50, the necessity of supraclavicular root exploration should balance patient factors, presentation timing, and concomitant injuries.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnosis II.
臂丛神经损伤患者的重建极具挑战性。根分析评分由 311 例臂丛神经损伤患者的简约多变量模型得出，通过四个类别确定 C5 神经是否具有活力：C5 Tinel 试验阳性、CT 脊髓造影显示 C5 神经完整、无膈肌抬高以及颈中旁正中棘突无震颤。
对另一组臂丛神经损伤患者计算根分析评分。根据锁骨上探查和术中电生理测试，基于是否存在可移植 C5 神经根，验证评分的有效性。计算评分的受试者工作特征曲线、准确性和一致性统计数据。根据四分位数将评分分为三个根分析评分组：<50 分（低）、50-75 分（中）和 75-100 分（高），并将最低的两个评分组合。根据术中评估，各评分组的 C5 神经可用性的概率、灵敏度和特异性。
共纳入 80 例患者（平均年龄 33.1 岁；15 名女性和 65 名男性）。31 例（39%）患者存在可存活的 C5 神经。根分析计算器的总体准确率为 82.5%，受试者工作特征为 0.87，一致性统计数据为 0.87，表明具有较高的总体预测价值；评分<50 分的患者中有 6.5%（94%的灵敏度和 43%的特异性）、评分 50-75 分的患者中有 16.1%（94%的灵敏度和 67%的特异性）和评分 75-100 分的患者中有 77.4%（77%的灵敏度和 90%的特异性）有可移植的 C5 神经。
根分析评分对 C5 神经的活力具有较高的准确性和预测能力。在评分<50 分的患者中，锁骨上神经根探查的必要性应权衡患者因素、就诊时间和伴随损伤。
研究类型/证据水平：诊断 II 级。
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