Paul S D, Gellman H, Waters R, Willstein G, Tognella M
Rancho Los Amigos Medical Center, Downey, California.
J Bone Joint Surg Am. 1994 Oct;76(10):1451-6. doi: 10.2106/00004623-199410000-00003.
The results in ten arms of nine patients who had post-traumatic tetraplegia at the fifth or sixth cervical level were reviewed after combined transfer of the brachioradialis to the flexor pollicis longus and of the posterior part of the deltoid to the triceps tendon to restore key pinch and extension of the elbow. The average age of the patients was twenty-nine years, the average time from the injury to the operation was five years, and the average duration of follow-up was thirty-one months. Key pinch improved from essentially none preoperatively to an average of 2.0 pounds (0.9 kilogram) postoperatively: an average of 3.0 pounds (1.4 kilograms) for the patients who had tetraplegia at the sixth cervical level and an average of 0.9 pound (0.4 kilogram) for those who had tetraplegia at the fifth cervical level. Key pinch was favorably influenced by extension of the wrist, while the position of the elbow had no effect. Maximum active extension of the elbow against gravity was within 20 degrees of full extension in eight of the ten arms. There was an improvement in the performance of activities of daily living, including wheelchair use, and most of the patients discontinued use of special equipment for the upper extremity. The results of this study, when compared with those of each procedure performed separately, suggest that a combination of the operations improves function of the upper extremity and shortens the duration of dependence postoperatively.
对9例第五或第六颈椎水平创伤性四肢瘫痪患者的10侧上肢，在将肱桡肌转移至拇长屈肌以及将三角肌后部转移至肱三头肌腱以恢复关键捏力和伸肘功能后进行了结果评估。患者的平均年龄为29岁，受伤至手术的平均时间为5年，平均随访时间为31个月。关键捏力从术前基本没有改善到术后平均为2.0磅（0.9千克）：第六颈椎水平四肢瘫痪的患者平均为3.0磅（1.4千克），第五颈椎水平四肢瘫痪的患者平均为0.9磅（0.4千克）。关键捏力受腕关节伸展的有利影响，而肘关节位置无影响。10侧上肢中有8侧在抗重力情况下肘关节的最大主动伸展在完全伸展的20度范围内。包括轮椅使用在内的日常生活活动能力有所改善，大多数患者停止使用上肢特殊设备。与分别进行每种手术的结果相比，本研究结果表明，联合手术可改善上肢功能并缩短术后依赖时间。
