Injury and Biological Factors Impact Shoulder Function following Autogenous Grafting of Spinal Nerves for Pan-Brachial Plexus Reconstruction.

IF 3.2 2区医学 Q1 SURGERY

Plastic and reconstructive surgery Pub Date : 2024-11-01 Epub Date: 2024-04-02 DOI:10.1097/PRS.0000000000011270

Neill Y Li, Kitty Y Wu, Michelle F Loosbrock, Allen T Bishop, Robert J Spinner, Alexander Y Shin

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引用次数: 0

Abstract

Background: Shoulder function after spinal nerve grafting in pan-brachial plexus injuries (pan-BPI) is not well described. The authors evaluated shoulder abduction (ABD) and external rotation (ER) after spinal nerve grafting to the suprascapular nerve, axillary nerve, or posterior division of the upper trunk and determined patient characteristics, injury severity and characteristics, and nerve graft factors that influenced outcomes.

Methods: A total of 362 patients undergoing pan-BPI reconstruction and spinal nerve grafting for shoulder reanimation in a single institution between 2001 and 2018 were reviewed. Patient demographics, Injury Severity Score (ISS), graft characteristics, strength, range of motion for shoulder ABD and ER, and patient-reported outcomes were recorded. Patients were divided into 3 groups based on recovery of shoulder function: no return, ABD only, and ABD and ER.

Results: A total of 110 patients underwent spinal nerve grafting, with 41 meeting inclusion criteria. Seventeen (41.5%) had no return of shoulder function, 14 (34.1%) had ABD alone, and 10 (24.4%) had ABD and ER. Patients with recovery of both ABD and ER were significantly younger (18.6 ± 5.56 years), had lower body mass index (22.4 ± 4.0), and had a lower ISS (10.5 ± 6.24; P = 0.003). Multivariable analysis found that with increasing age (OR, 0.786; 95% CI, 0.576, 0.941) and ISS (OR, 0.820; 95% CI, 0.606, 0.979), odds for return of ABD and ER decreased significantly.

Conclusions: In pan-BPI, 24.4% of patients demonstrated return of both ABD and ER after spinal nerve grafting to suprascapular nerve and either axillary nerve or posterior division of the upper trunk. Age, body mass index, and ISS were associated with poorer recovery of shoulder function. Careful patient selection and consideration of age, body mass index, and ISS may improve outcomes of spinal nerve grafting for shoulder reanimation.

Clinical question/level of evidence: Risk, III.

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自体脊神经移植用于泛臂丛神经重建术后，损伤和生物学因素对肩关节功能的影响。

背景：泛臂丛神经损伤（Pan-BPI）脊神经移植后的肩关节功能尚未得到很好的描述。本研究有两个目的：1）评估将有活力的脊神经移植到肩胛上神经（SSN）、腋神经（AxN）或上干后部（PDUT）后的肩关节外展（ABD）和外旋（ER）情况；2）确定患者特征、损伤严重程度/特征以及影响结果的神经移植因素。方法：对一家机构的 362 例泛 BPI 重建患者进行了回顾性研究，这些患者在 2001 年至 2018 年期间接受了脊神经移植肩关节再植术。记录了患者的人口统计学特征、损伤严重程度评分（ISS）、移植特征、力量、肩部ABD和ER的活动范围以及患者报告的结果。根据肩关节功能恢复情况将患者分为三组：无恢复、仅ABD、ABD和ER：110名患者接受了脊神经移植手术，其中41人符合纳入标准。17例（41.5%）肩部功能未恢复，14例（34.1%）仅有ABD，10例（24.4%）有ABD和ER。ABD和ER均恢复的患者明显更年轻（18.6±5.56），体重指数更低（22.4±4.0），ISS更低（10.5±6.24，P=0.003）。多变量分析发现，随着年龄（OR:0.786, 95%CI:0.576,0.941）和ISS（OR:0.820, 95%CI:0.606-0.979）的增加，ABD和ER复发的几率明显降低：在Pan-BPI中，24.4%的患者在脊神经移植到SSN和AxN或PDUT后出现ABD和ER复发。年龄、体重指数（BMI）和ISS与肩关节功能恢复较差有关。谨慎选择患者并考虑年龄、体重指数和ISS可改善脊神经移植肩关节再植术的效果：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

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