Free Functioning Gracilis Muscle Transfer versus Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion after Traumatic Adult Brachial Pan-Plexus Injury
Free Functioning Gracilis Muscle Transfer versus Intercostal Nerve Transfer to Musculocutaneous Nerve for Restoration of Elbow Flexion after Traumatic Adult Brachial Pan-Plexus Injury
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DOI：
10.1097/prs.0000000000002471
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发表时间：
2016-09-01
影响因子：
3.6
通讯作者：
Shin, Alexander Y.
中科院分区：
文献类型：
--
作者：
Maldonado, Andres A.;Kircher, Michelle F.;Shin, Alexander Y.
背景资料：五节段臂丛神经根性损伤后，游离功能性肌肉移位及肋间神经移位至肌皮神经是屈肘功能重建的两种可能选择。本研究的目的是确定结果的自由功能性肌肉转移肋间神经到肌皮神经转移相对于strength.Methods：62例患者进行了自由功能性肌肉转移重建或肋间神经到肌皮神经转移肘屈曲后，泛丛损伤。根据英国医学研究理事会分级系统比较两组术后肘关节屈曲强度;术前和术后手臂、肩和手残疾问卷scores.Results：在游离功能性肌肉转移组中，67.7%的患者实现了M3或M4肘关节屈曲。在肋间神经-肌皮神经移位组中，41.9%的患者实现了M3或M4肘关节屈曲。差异有统计学意义（p < 0.05）。手臂、肩部和手部残疾问卷评分的变化无统计学显著性。两组从受伤到手术的平均时间有显著差异（p < 0.01）。肋间神经用于肌皮神经转移的数量没有相关性，更好的肘关节屈曲grade.Conclusions：根据这项研究，股薄肌游离功能性肌肉转移重建达到更好的肘关节屈曲力量比肋间神经到肌皮神经转移后，全丛损伤肘关节屈曲。股薄肌游离功能性肌移位在急性重建中的作用应慎重考虑。
Background: After complete five-level root brachial plexus injury, free functional muscle transfer and intercostal nerve transfer to the musculocutaneous nerve are two potential reconstructive options for elbow flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus intercostal nerve-to-musculocutaneous nerve transfers with respect to strength.Methods: Sixty-two patients who underwent free functional muscle transfer reconstruction or intercostal nerve-to-musculocutaneous nerve transfer for elbow flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative elbow flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores.Results: In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 elbow flexion. In the intercostal nerve-to-musculocutaneous nerve transfer group, 41.9 percent of patients achieved M3 or M4 elbow flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of intercostal nerves used for the musculocutaneous nerve transfer did not correlate with better elbow flexion grade.Conclusions: Based on this study, gracilis free functional muscle transfer reconstruction achieves better elbow flexion strength than intercostal nerve-to-musculocutaneous nerve transfer for elbow flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction.