NERVE TRANSFER SURGERY FOR ADULT BRACHIAL PLEXUS INJURY: A 10‐YEAR EXPERIENCE AT LOUISIANA STATE UNIVERSITY
NERVE TRANSFER SURGERY FOR ADULT BRACHIAL PLEXUS INJURY: A 10‐YEAR EXPERIENCE AT LOUISIANA STATE UNIVERSITY
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DOI：
10.1227/01.neu.0000341165.83218.ac
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发表时间：
2009-10
期刊：
影响因子：
4.8
通讯作者：
O. Sulaiman;Daniel D Kim;Clinton J. Burkett;D. Kline
中科院分区：
文献类型：
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作者：
O. Sulaiman;Daniel D Kim;Clinton J. Burkett;D. Kline
目的回顾 10 年来在路易斯安那州立大学 (LSU) 接受神经转移手术进行臂丛神经重建的患者的临床结果。第二个目标是比较仅接受神经转移手术的患者与接受神经转移并辅以臂丛神经元件直接修复的患者的临床结果。方法回顾性回顾 10 年来在路易斯安那州立大学接受神经转移手术的臂丛神经损伤患者的医疗记录、影像学和电诊断研究（肌电图和神经传导研究）。结果 1995 年至 2005 年间，路易斯安那州立大学健康科学中心总共治疗了 81 名患者；其中 7 名患者失访，剩下 74 名患者需要复查，平均随访时间为 3.5 年。我们评估了肘部屈曲和肩部外展的恢复情况。 90% 的胸内侧神经至肌皮神经转移患者恢复至 LSU 2 级（医学研究委员会 3 级），而肋间至肌皮神经转移的患者中 60% 的肘部屈曲恢复了类似的力量。脊柱附件至肩胛上神经和/或胸背神经至腋神经转移后，肩部外展恢复至 LSU 2 级（医学研究委员会 3 级）的比例分别为 95% 和 36%。当神经转移手术与神经丛元件的直接修复相结合时，有更好的运动恢复趋势。结论 用于修复臂丛神经损伤的神经转移可以使肘部和肩部功能得到良好的恢复。除神经移植外还接受臂丛神经元件直接修复的患者往往比仅接受神经移植手术的患者效果更好。
OBJECTIVETo review the clinical outcomes in our patients who have undergone nerve transfer operations for brachial plexus reconstruction at the Louisiana State University (LSU) over a 10-year period. A secondary objective is to compare clinical outcomes in patients who had only nerve transfer operations as compared with patients whose nerve transfers were supplemented with direct repair of brachial plexus elements. METHODSRetrospective review of the medical records, imaging, and electrodiagnostic studies (electromyographic and nerve conduction studies) of patients with brachial plexus injuries who underwent nerve transfer operations at LSU over a period of 10 years. RESULTSA total of 81 patients were treated between 1995 to 2005 at the LSU Health Sciences Center; 7 of these patients were lost to follow-up, leaving 74 patients, with an average follow-up of 3.5 years, for review. We evaluated recovery of elbow flexion and shoulder abduction. Ninety percent of patients with medial pectoral to musculocutaneous nerve transfers recovered to LSU grade 2 (Medical Research Council grade 3), and 60% of those patients with intercostal to musculocutaneous nerve transfer regained similar strength in elbow flexion. Shoulder abduction recovery to LSU grade 2 (Medical Research Council grade 3) after spinal accessory to suprascapular and/or thoracodorsal to axillary nerve transfer, was 95% and 36%, respectively. There was a tendency for better motor recovery when nerve transfer operations were combined with direct repair of plexus elements. CONCLUSIONNerve transfers for repair of brachial plexus injuries result in excellent recovery of elbow and shoulder functions. Patients who had direct repair of brachial plexus elements in addition to nerve transfers tended to do better than those who had only nerve transfer operations.