Acute Flaccid Myelitis: Mid-Term Clinical Course of Knee Extension Paralysis and Outcomes of Nerve Transfer.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-10-16 Epub Date: 2024-05-30 DOI:10.2106/JBJS.23.01268

Kazuteru Doi, Yasunori Hattori, Akio Maruyama, Abdelhakim Ezzat Marei, Sotetsu Sakamoto, Jun Sasaki, Kota Hayashi, Makimi Fujita

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引用次数: 0

Abstract

Background: Acute flaccid myelitis (AFM) is a rare debilitating poliomyelitis-like illness characterized by the sudden onset of flaccid palsy in the extremities. The purpose of this study was to report the mid-term clinical course of knee extension in AFM and the effect of contralateral obturator nerve-to-femoral nerve transfer (CONFNT) for restoration of knee extension in AFM.

Methods: Twenty-six patients with lower extremity palsy due to AFM were referred to our clinic for possible surgical reconstruction. Their median age was 4.0 years, and the first evaluation of the palsy was done at a mean of 6 months after paralysis onset. The paralysis ranged from lower limb monoplegia to quadriplegia. The clinical course of knee extension was assessed using the British Medical Research Council (MRC) grading scale and surface electromyography (EMG). Five patients with unilateral paralysis of knee extension underwent CONFNT.

Results: The mean follow-up period for 19 limbs with complete paralysis of knee extension (MRC grade M0) in 13 patients who were evaluated for spontaneous recovery was 43 months. No patient who had complete paralysis of knee extension at >6 months and paralysis of the hip adductor muscle had improvement of knee extension to better than M2. Five of the original 26 patients were treated with CONFNT and followed for a mean of 61 months. Two of 5 patients had the CONFNT ≤8 months after paralysis onset and obtained M4 knee extension. Only 1 of the 3 patients with CONFNT performed approximately 12 months after paralysis onset obtained M3 knee extension; the other 2 obtained only M1 or M2 knee extension.

Conclusions: The paralysis of the lower extremity in our patients with AFM was similar to that in poliomyelitis. However, in AFM, spontaneous recovery of knee extension was possible if there were signs of recovery from hip adductor paralysis up to 6 months after paralysis onset. CONFNT may enhance the recovery of knee extension and seems to be a reliable reconstruction for restoring knee extension if performed no more than 8 months after paralysis onset.

Level of evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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急性弛缓性脊髓炎膝关节外展麻痹的中期临床表现和神经转移的结果

背景：急性弛缓性脊髓炎（AFM）是一种罕见的致残性脊髓灰质炎样疾病，以突然出现四肢弛缓性麻痹为特征。本研究旨在报告弛缓性脊髓炎患者膝关节伸展的中期临床过程，以及对侧闭孔神经-股神经转移（CONFNT）对恢复弛缓性脊髓炎患者膝关节伸展的效果：本诊所共收治了26名下肢麻痹患者，他们都是因下肢麻痹导致的下肢麻痹，可能需要进行手术重建。他们的中位年龄为 4.0 岁，首次瘫痪评估平均在瘫痪发生后 6 个月进行。瘫痪程度从下肢单瘫到四肢瘫痪不等。采用英国医学研究委员会（MRC）的分级表和表面肌电图（EMG）对膝关节伸展的临床过程进行了评估。五名单侧伸膝瘫痪患者接受了 CONFNT：结果：13 名患者的 19 条伸膝完全瘫痪肢体（MRC 分级 M0）的平均随访时间为 43 个月，并对其自发康复情况进行了评估。膝关节伸展完全麻痹时间超过 6 个月且髋关节内收肌麻痹的患者中，没有人的膝关节伸展能力改善到 M2 以上。在最初的 26 位患者中，有 5 位接受了 CONFNT 治疗，平均随访时间为 61 个月。5名患者中有2人在瘫痪开始后≤8个月接受了CONFNT治疗，并获得了M4级膝关节伸展能力。在瘫痪发生约12个月后接受CONFNT治疗的3名患者中，只有1人获得了M3膝关节伸展；另外2人仅获得了M1或M2膝关节伸展：结论：下肢瘫痪症患者的下肢瘫痪情况与脊髓灰质炎患者相似。然而，如果髋关节内收肌麻痹患者在瘫痪后 6 个月内出现恢复迹象，则有可能自发恢复伸膝功能。CONFNT可促进膝关节伸展的恢复，如果在瘫痪发生后8个月内进行CONFNT，似乎是恢复膝关节伸展的可靠重建方法：证据等级：治疗IV级。有关证据等级的完整描述，请参阅 "作者须知"。

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

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.