Treatment of Complete Brachial Plexus Injuries Using Double Free Muscle Transfer

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2025-03-01 DOI:10.1016/j.jhsa.2023.09.005

Ryosuke Kakinoki MD, PhD , Kazuhiro Ohtani MD, PhD , Souichi Ohta MD, PhD , Ryosuke Ikeguchi MD, PhD , Masao Akagi MD, PhD , Koji Goto MD, PhD

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引用次数: 0

Abstract

Purpose

The purpose of this study was to examine the surgical outcomes of double free muscle transfer (DFMT) performed in patients with complete brachial plexus injury (BPI).

Methods

We retrospectively analyzed the outcomes of DFMT for 12 patients with complete BPI who were followed up for more than 2 years after the final muscle transplantation. Their mean age was 29 years (range, 18–41). Three patients underwent contralateral C7 nerve root transfer before the DFMT. The range of motion (ROM) of the shoulder, elbow, and fingers was measured. Patient-reported outcome measures, including Disability of the Shoulder, Arm, and Hand (DASH) scores and visual analog scale (VAS) scores for pain, were also examined.

Results

The mean shoulder ROM against gravity was 22° ± 8° in abduction and 33° ± 5° in flexion. Seven patients underwent phrenic nerve (PhN) transfer to the suprascapular nerves, and five exhibited asymptomatic lung impairment on spirography more than 2 years after PhN transfer. The mean elbow ROM against gravity was 111° ± 9° in flexion and –32° ± 7° in extension. All patients obtained elbow flexion >90° against a 0.5-kg weight. All patients obtained touch sensation and two recognized warm and cold sensations in the affected palm. The mean total active motion of the affected fingers was 44° ± 11°. All patients exhibited hook function of the hands. The mean preoperative and postoperative DASH scores were 70.3 ± 13.4 and 51.8 ± 15.9, respectively. The mean pain VAS score was 28 ± 31 at the final follow-up.

Conclusions

Double free muscle transfer provided patients with complete brachial plexus palsy with good elbow flexion and hand hook functions.

Type of study/level of evidence

Therapeutic IV.

查看原文本刊更多论文

双自由肌转移治疗完全性臂丛损伤。

目的：本研究的目的是检查完全性臂丛神经损伤（BPI）患者进行双自由肌转移（DFMT）的手术结果。方法：我们回顾性分析了12例完全性BPI患者的DFMT结果，这些患者在最后一次肌肉移植后随访了2年以上。他们的平均年龄为29岁（18-41岁）。三名患者在DFMT前接受了对侧C7神经根移植。测量肩部、肘部和手指的活动范围（ROM）。还检查了患者报告的结果测量，包括肩、臂和手残疾（DASH）评分和疼痛视觉模拟量表（VAS）评分。结果：外展时肩关节对重力的平均ROM为22°±8°，屈曲时为33°±5°。7名患者接受了膈神经（PhN）转移到肩胛上神经的手术，5名患者在PhN转移后2年以上的肺活量描记术中表现出无症状的肺损伤。屈曲时肘部相对于重力的平均ROM为111°±9°，伸展时为-32°±7°。所有患者的肘部弯曲度均大于90°，重量为0.5 kg。所有患者在受影响的手掌中都获得了触觉和两种可识别的温暖和寒冷感觉。受影响手指的平均总活动度为44°±11°。所有患者均表现出手钩功能。术前和术后平均DASH评分分别为70.3±13.4和51.8±15.9。最终随访时，平均疼痛VAS评分为28±31。结论：双自由肌移位术为完全性臂丛神经麻痹患者提供了良好的屈肘和钩手功能。研究类型/证据水平：治疗IV。

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 Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.