Nerve transfers to anterior interosseous nerve for restoration of finger flexion in spinal cord and brachial plexus injury: a systematic Review and individual-patient-data meta-analysis.
Pavlos Texakalidis, Stavros Matsoukas, Nikhil Murthy, Adenike A Adewuyi, Nader S Dahdaleh, Colin K Franz, Kevin Swong
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引用次数: 0
Abstract
Study design: Systematic review and meta-analysis.
Objectives: Cervical spinal cord injury (SCI) and brachial plexus injury (BPI) can result in hand paralysis. Reconstruction of hand motion is associated with improved functionality and quality of life. We synthesized the outcomes of finger and thumb flexion after various nerve transfers to the anterior interosseous nerve (AIN).
Methods: A systematic literature review and meta-analysis was performed according to the PRISMA guidelines. Successful finger and thumb flexion recovery was defined as Medical research council (MRC) grade ≥3.
Results: In total, 23 studies with 99 patients and 120 nerve transfers to the AIN were performed. The mean interval from injury to surgery was 12.8 months and mean follow-up duration was 24 months. Overall, 81/120 (67.5%) and 68/102 (66.7%) hands achieved successful finger and thumb flexion recovery, respectively. Individual-patient-data were available for 94 nerve transfers. Type of injury (SCI vs BPI/peripheral) did not affect finger flexion outcomes (OR 1.92, 95%CI 0.74-5.0, p = 0.17). On multivariate analysis adjusted for mechanism of injury, timing of injury to surgery and duration of follow-up, utilization of the brachioradialis (BR) branch (25%, 1/4, OR 0.01, 95%CI 0.0006-0.44, p = 0.01) and brachialis (BA) branch (59%, 30/51, OR 0.06, 95%CI 0.006-0.68, p = 0.02) as donors, were associated with statistically significant lower odds of successful finger flexion recovery compared to extensor carpi radialis brevis (ECRB) use (95%, 19/20).
Conclusions: Similar outcomes were observed with SCI and BPI/peripheral type injuries. ECRB utilization as a donor was superior to BA or BR branch in terms of successful finger flexion recovery.
期刊介绍：
Spinal Cord is a specialised, international journal that has been publishing spinal cord related manuscripts since 1963. It appears monthly, online and in print, and accepts contributions on spinal cord anatomy, physiology, management of injury and disease, and the quality of life and life circumstances of people with a spinal cord injury. Spinal Cord is multi-disciplinary and publishes contributions across the entire spectrum of research ranging from basic science to applied clinical research. It focuses on high quality original research, systematic reviews and narrative reviews.
Spinal Cord''s sister journal Spinal Cord Series and Cases: Clinical Management in Spinal Cord Disorders publishes high quality case reports, small case series, pilot and retrospective studies perspectives, Pulse survey articles, Point-couterpoint articles, correspondences and book reviews. It specialises in material that addresses all aspects of life for persons with spinal cord injuries or disorders. For more information, please see the aims and scope of Spinal Cord Series and Cases.
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