Surgical strategies for brachial plexus polio-like paralysis
Surgical strategies for brachial plexus polio-like paralysis
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DOI：
10.1097/01.prs.0000267420.76840.5f
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发表时间：
2007-08-01
影响因子：
3.6
通讯作者：
Schrag, Christiaan
中科院分区：
文献类型：
--
作者：
Liao, Han-Tsung;Chuang, David Chwei-Chin;Schrag, Christiaan
背景：臂丛脊髓灰质炎样麻痹是病毒感染后上肢的急性松驰性瘫痪。瘫痪肢体的手术方法在以前的文献中没有被讨论过。本研究首次描述了脊髓灰质炎样瘫痪的临床病程并提出了手术治疗策略。方法：1982-2004年间，17例患者(男1例，女6例)出现上肢急性迟缓性瘫痪。回顾其临床病程。平均发病年龄为2岁(4个月至13岁)。所有患者均有肩外展和/或屈肘功能障碍。结果：在瘫痪1年内接受神经移位的5例患者，根据Gilbert分类，肩关节外展恢复到V级(>；160度)。1例瘫痪3年后接受神经移位治疗的患者仅获得I期外展(45度)。在两名患者中，对于肩部外展功能障碍，进行了多次局部肌肉移位，导致从I期到11期的轻微改善(<；90度)。4例行功能性游离肌肉移植屈肘，均恢复功能M4肌力。非手术组7例，其中2例在术后1年内完全自愈，5例有永久性残肢瘫痪，平均随访10年。结论：本病应考虑手术治疗，包括在发病后1年内对肩外展功能障碍进行神经移位，对晚期屈肘功能障碍进行功能性肌肉移植。晚期重建，无论是通过神经移位或使用局部多肌移位进行肩外展，都是无效的。
Background: Brachial plexus polio-like paralysis is an acute flaccid paralysis of the upper limb following viral infection. Surgical approaches to the paralytic limb have not previously been discussed in the literature. This study is the first to describe the clinical course and propose a surgical strategy for disabilities related to poliomyelitis-like paralysis.Methods: Between 1982 and 2004, 17 patients (I I boys and six girls) presented with acute flaccid paralysis of the upper limb. Their clinical course was reviewed retrospectively. Average age at onset of disease was 2 years (range, 4 months to 13 years). All patients had disability in shoulder abduction and/or elbow flexion. Ten patients underwent reconstructive surgery.Results: Stage V shoulder abduction (> 160 degrees) according to Gilbert's classification was regained in five patients who underwent nerve transfer within I year of paralysis. One patient treated by nerve transfer after 3 years of paralysis obtained only stage I abduction (< 45 degrees). In two patients, multiple local muscle transfers were performed for the shoulder abduction disability, resulting in mild improvement from stage I to stage 11 abduction (< 90 degrees). In four patients, functioning free muscle transplantation for elbow flexion was carried out, and all regained functional M4 muscle strength. Of seven patients in the nonsurgical group, two had complete spontaneous recovery within I year, but five had permanent residual limb paralysis at a mean follow-up of 10 years.Conclusions: Surgical strategies, including nerve transfer for shoulder abduction deficit,within I year after attack and functioning free muscle transplantation for the elbow flexion deficit in the late period, should be considered for this disease. Late reconstruction, either by nerve transfer or by using local multiple muscle transfer for shoulder abduction, is ineffective.