术中神经电刺激作为周围神经松解术患者的预后工具

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-01-01 DOI:10.1016/j.jhsg.2024.10.004

Christoph A. Schroen BS , Yufan Yan MD , Christian E. Awah MD , Unwana Abasi MD , Paul J. Cagle MD , Michael R. Hausman MD , Steven M. Koehler MD

{"title":"术中神经电刺激作为周围神经松解术患者的预后工具","authors":"Christoph A. Schroen BS , Yufan Yan MD , Christian E. Awah MD , Unwana Abasi MD , Paul J. Cagle MD , Michael R. Hausman MD , Steven M. Koehler MD","doi":"10.1016/j.jhsg.2024.10.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Functional recovery from peripheral nerve injuries remains unpredictable and continues to pose a major clinical challenge to surgeons. This study sought to investigate the utility of intraoperative nerve stimulation following neurolysis surgery as a prognostic indicator of functional recovery.</div></div><div><h3>Methods</h3><div>A retrospective chart review of adult patients who underwent peripheral nerve neurolysis between September 2021 and December 2022 was performed. A handheld nerve stimulator was used intraoperatively before and after neurolysis. Patients with preoperative motor deficits corresponding to the nerve that underwent neurolysis, intraoperative nerve stimulation, and postoperative follow-up length of at least 3 months were included. Muscle strength as measured by the Medical Research Council scale was used to evaluate nerve function. A scale grade of 0 or 1 meant “no recovery,” between 2 and 4 was classified as “partial recovery,” and 5 was classified as “full recovery.” Fisher exact tests were employed to test for an association between stimulation thresholds and functional recovery.</div></div><div><h3>Results</h3><div>A total of 27 patients and 45 nerves were included in the study, with a mean follow-up of 8.0 months. Intraoperative stimulation at 0.5 mA was observed in 73% (33/45) of nerves, with 76% achieving full recovery, 18% partial recovery, and 6% no recovery. Two nerves stimulated at 2 mA and one at 20 mA, with both showing partial recovery. In contrast, 22% (10/45) of nerves showed no stimulation, leading to full recovery in 20%, partial recovery in 30%, and no recovery in 50% of cases. A significant (<em>P</em> < .001) association was found between stimulation thresholds and functional recovery.</div></div><div><h3>Conclusions</h3><div>Intraoperative nerve stimulation is strongly linked to functional recovery postneurolysis, demonstrating its potential as a prognostic tool for guiding surgical decisions.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic, IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 1","pages":"Pages 61-65"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis\",\"authors\":\"Christoph A. Schroen BS , Yufan Yan MD , Christian E. Awah MD , Unwana Abasi MD , Paul J. Cagle MD , Michael R. Hausman MD , Steven M. Koehler MD\",\"doi\":\"10.1016/j.jhsg.2024.10.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Functional recovery from peripheral nerve injuries remains unpredictable and continues to pose a major clinical challenge to surgeons. This study sought to investigate the utility of intraoperative nerve stimulation following neurolysis surgery as a prognostic indicator of functional recovery.</div></div><div><h3>Methods</h3><div>A retrospective chart review of adult patients who underwent peripheral nerve neurolysis between September 2021 and December 2022 was performed. A handheld nerve stimulator was used intraoperatively before and after neurolysis. Patients with preoperative motor deficits corresponding to the nerve that underwent neurolysis, intraoperative nerve stimulation, and postoperative follow-up length of at least 3 months were included. Muscle strength as measured by the Medical Research Council scale was used to evaluate nerve function. A scale grade of 0 or 1 meant “no recovery,” between 2 and 4 was classified as “partial recovery,” and 5 was classified as “full recovery.” Fisher exact tests were employed to test for an association between stimulation thresholds and functional recovery.</div></div><div><h3>Results</h3><div>A total of 27 patients and 45 nerves were included in the study, with a mean follow-up of 8.0 months. Intraoperative stimulation at 0.5 mA was observed in 73% (33/45) of nerves, with 76% achieving full recovery, 18% partial recovery, and 6% no recovery. Two nerves stimulated at 2 mA and one at 20 mA, with both showing partial recovery. In contrast, 22% (10/45) of nerves showed no stimulation, leading to full recovery in 20%, partial recovery in 30%, and no recovery in 50% of cases. A significant (<em>P</em> < .001) association was found between stimulation thresholds and functional recovery.</div></div><div><h3>Conclusions</h3><div>Intraoperative nerve stimulation is strongly linked to functional recovery postneurolysis, demonstrating its potential as a prognostic tool for guiding surgical decisions.</div></div><div><h3>Type of study/level of evidence</h3><div>Prognostic, IV.</div></div>\",\"PeriodicalId\":36920,\"journal\":{\"name\":\"Journal of Hand Surgery Global Online\",\"volume\":\"7 1\",\"pages\":\"Pages 61-65\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hand Surgery Global Online\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589514124002123\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery Global Online","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589514124002123","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

目的周围神经损伤的功能恢复仍然是不可预测的，并继续对外科医生提出重大的临床挑战。本研究旨在探讨神经松解术后术中神经刺激作为功能恢复的预后指标的效用。方法对2021年9月至2022年12月行周围神经松解术的成人患者进行回顾性分析。术中神经松解前后使用手持式神经刺激器。患者术前运动障碍与行神经松解术的神经相对应，术中神经刺激，术后随访时间至少3个月。用医学研究委员会量表测量的肌肉力量来评估神经功能。0到1级表示“无法恢复”，2到4级为“部分恢复”，5级为“完全恢复”。采用Fisher精确检验来检验刺激阈值与功能恢复之间的关系。结果共纳入27例患者，45根神经，平均随访8.0个月。术中0.5 mA刺激73%（33/45）神经，76%完全恢复，18%部分恢复，6%未恢复。2 mA刺激2条神经，20 mA刺激1条神经，均部分恢复。相比之下，22%（10/45）的神经无刺激，20%完全恢复，30%部分恢复，50%未恢复。P <；.001)刺激阈值与功能恢复之间存在关联。结论术中神经刺激与神经松解术后功能恢复密切相关，显示其作为指导手术决策的预后工具的潜力。研究类型/证据水平预后，IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Intraoperative Electrical Nerve Stimulation as a Prognostic Tool in Patients Undergoing Peripheral Nerve Neurolysis

Purpose

Functional recovery from peripheral nerve injuries remains unpredictable and continues to pose a major clinical challenge to surgeons. This study sought to investigate the utility of intraoperative nerve stimulation following neurolysis surgery as a prognostic indicator of functional recovery.

Methods

A retrospective chart review of adult patients who underwent peripheral nerve neurolysis between September 2021 and December 2022 was performed. A handheld nerve stimulator was used intraoperatively before and after neurolysis. Patients with preoperative motor deficits corresponding to the nerve that underwent neurolysis, intraoperative nerve stimulation, and postoperative follow-up length of at least 3 months were included. Muscle strength as measured by the Medical Research Council scale was used to evaluate nerve function. A scale grade of 0 or 1 meant “no recovery,” between 2 and 4 was classified as “partial recovery,” and 5 was classified as “full recovery.” Fisher exact tests were employed to test for an association between stimulation thresholds and functional recovery.

Results

A total of 27 patients and 45 nerves were included in the study, with a mean follow-up of 8.0 months. Intraoperative stimulation at 0.5 mA was observed in 73% (33/45) of nerves, with 76% achieving full recovery, 18% partial recovery, and 6% no recovery. Two nerves stimulated at 2 mA and one at 20 mA, with both showing partial recovery. In contrast, 22% (10/45) of nerves showed no stimulation, leading to full recovery in 20%, partial recovery in 30%, and no recovery in 50% of cases. A significant (P < .001) association was found between stimulation thresholds and functional recovery.

Conclusions

Intraoperative nerve stimulation is strongly linked to functional recovery postneurolysis, demonstrating its potential as a prognostic tool for guiding surgical decisions.