Dengler Jana, Perlman Maytal, Jennett Michelle, Marcon Edyta, Guilcher Sara
Division of Plastic and Reconstructive Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Plast Surg (Oakv). 2024 Aug;32(3):367-373. doi: 10.1177/22925503221120544. Epub 2022 Aug 22.
Upper limb function loss in cervical spinal cord injury (SCI) contributes to substantial disability, and negatively impacts quality of life. Nerve transfer and tendon transfer surgery can provide improved upper limb function. This study assessed the utilization of nerve and tendon transfer surgery for individuals with tetraplegia in Canada. Data from the Canadian Institute for Health Information's Discharge Abstracts Database and the National Ambulatory Care Reporting System were used to identify the nerve and tendon transfer procedures performed in individuals with tetraplegia (2004-2020). Cases were identified using cervical SCI ICD-10-CA codes and Canadian Classification of Intervention codes for upper extremity nerve and tendon transfers. Data on sex, age at time of procedure, province, and hospital stay duration were recorded. From 2004 to 2020, there were ≤80 nerve transfer procedures (81% male, mean age 38.3 years) and 61 tendon transfer procedures (78% male, mean age 45.0 years) performed (highest in Ontario and British Columbia). Using an estimate of 50% eligibility, an average of 1.3% of individuals underwent nerve transfer and 1.0% underwent tendon transfer. Nerve transfers increased over time (2004-2009, n = <5; 2010-2015, n = 27; 2016-2019, n = 49) and tendon transfers remained relatively constant. Both transfer types were performed as day-surgery or single night stay. Nerve and tendon transfer surgery to improve upper limb function in Canadians with tetraplegia remains low. This study highlights a substantial gap in care for this vulnerable population. Identification of barriers that prevent access to care is required to promote best practice for upper extremity care.
颈脊髓损伤（SCI）导致的上肢功能丧失会造成严重残疾，并对生活质量产生负面影响。神经移植和肌腱移植手术可以改善上肢功能。本研究评估了加拿大四肢瘫痪患者神经和肌腱移植手术的应用情况。利用加拿大卫生信息研究所的出院摘要数据库和国家门诊护理报告系统的数据，确定了2004年至2020年期间四肢瘫痪患者所进行的神经和肌腱移植手术。通过颈脊髓损伤ICD - 10 - CA编码以及上肢神经和肌腱移植的加拿大干预分类编码来识别病例。记录了患者的性别、手术时年龄、省份和住院时间。2004年至2020年期间，共进行了≤80例神经移植手术（男性占81%，平均年龄38.3岁）和61例肌腱移植手术（男性占78%，平均年龄45.0岁）（安大略省和不列颠哥伦比亚省的手术量最高）。按照50%的符合条件估计，平均有1.3%的患者接受了神经移植，1.0%的患者接受了肌腱移植。神经移植手术量随时间增加（2004 - 2009年，n = <5；2010 - 2015年，n = 27；2016 - 2019年，n = 49），而肌腱移植手术量相对保持稳定。两种移植手术均作为日间手术或仅住院一晚进行。在加拿大，用于改善四肢瘫痪患者上肢功能的神经和肌腱移植手术的应用率仍然很低。本研究凸显了对这一弱势群体护理方面的巨大差距。需要找出阻碍获得护理的障碍，以促进上肢护理的最佳实践。
