Neurophysiological signals for estimation of the result of latissimus dorsii muscle transfer to biceps brachii in patients with arthrogryposis
Neurophysiological signals for estimation of the result of latissimus dorsii muscle transfer to biceps brachii in patients with arthrogryposis
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用于评估关节弯曲患者背阔肌转移至肱二头肌结果的神经生理信号
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发表时间：
2020
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通讯作者：
Yevgeny D. Blagoveshchenskiy
中科院分区：
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作者：
O. Agranovich;M. Savina;D. A. Ivanov;Alexey E. Boyko;Yevgeny D. Blagoveshchenskiy
背景。关节弯曲患者日常生活活动受限的主要原因之一是肱二头肌严重发育不全（或发育不全）。背阔肌转移至肱二头肌是关节弯曲患者重建主动肘关节最常用的方法之一。目的。该研究的目的是确定神经生理学相关因素，以评估多发性先天性关节弯曲患者背阔肌向二头肌移位的结果。材料和方法。 2011年至2018年，我们对30名关节弯曲患者（44个上肢）进行了单极背阔肌二头肌转移术，以恢复肘关节主动屈曲。对14例的随访结果进行了研究。为此，我们使用了临床检查、表面肌电图 (sEMG) 和统计分析。患者在术前和术后1个月至96个月（7个月；2-24.5个月）进行检查。患者手术时年龄为1岁至10岁（4.89±2.42岁）。结果。我们的研究表明，手术时孩子的年龄不会显着改变背阔肌的激活指数。从长远来看，手术后背阔肌共激活的减少与移位背阔肌力量的增加以及肘部主动屈曲的改善相关。如果背阔肌共激活指数值小于42%，则术后肌力达到4分。研究发现，背阔肌的共激活指数并不依赖于脊髓节段性损伤的程度。然而，肌肉的力量取决于脊髓损伤的程度。结论。术后背阔肌共激活指数的测定可用于评估关节弯曲患者背阔肌转移至肱二头肌的效果。背阔肌的激活指数必须小于 42%，才能有效肘部主动屈曲。
Background. One of the leading causes of restriction in daily-living activities in patients with arthrogryposis is severe hypoplasia (or aplasia) of the biceps brachii. Latissimus dorsii muscle transfer to the biceps brachii is one of the most used methods for the reconstruction of active elbow flexion in patients with arthrogryposis. Aim. The aim of the study is to identify neurophysiological correlates for evaluating the result of the transposition of the latissimus dorsii muscle to the biceps in patients with multiple congenital arthrogryposis. Materials and methods. From 2011 to 2018, we performed monopolar latissimus dorsii muscle transfer to the biceps for the restoration of active elbow flexion in 30 patients with arthrogryposis (44 upper extremities). The follow-up results were studied in 14 cases. For this purpose, we used clinical examination, surface electromyography (sEMG), and statistical analysis. The patients were examined before and from 1 month to 96 months (7 months; 2–24.5 months) after the surgery. The age of patients was from 1 to 10 years at the time of surgery (4.89 ± 2.42 years). Results. Our study showed that the age of the child at the time of surgery does not significantly change the index of activation of the latissimus dorsii muscle. A decrease of coactivation of the latissimus dorsii muscle in the long term after surgery correlates with an increase in the strength of the displaced latissimus dorsii muscle, and an improvement in active flexion in the elbow. If the value of the index of coactivation of the latissimus dorsii muscle is less 42%, the muscle strength after surgery reaches 4 points. It was found that the index of coactivation of the latissimus dorsii muscle does not depend on the level of segmental damage to the spinal cord. However, the strength of the muscle depends on the level of spinal cord damage. Conclusion. The determination of the index coactivation of the latissimus dorsii muscle after surgery can be used to evaluate the results of the latissimus dorsii muscle transfer to the biceps in patients with arthrogryposis. The index of activation of the latissimus dorsii muscle must be less than 42% for effective elbow active flexion.