全型および上位型腕神経叢損傷に対する神経移行および神経移植術を用いた肩肘機能の再建

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  • Reconstruction of Shoulder and Elbow Function Using Nerve Transfer and Graft for Total or Upper Type Brachial Plexus Injury

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We reviewed 30 cases of brachial plexus palsy (11 complete palsies, 19 upper palsies), with reconstruction of the shoulder abduction and elbow flexion using nerve transfer and/or graft. Clinical outcomes and surgical effectiveness were evaluated.<BR>The average age at surgery was 25.2 years, the average period from injury to surgery was 3.4 months, and minimum follow-up was 1 year, averaging 3.7 years.<BR>Regarding shoulder reconstruction, accessory nerve transfer to suprascapular nerve was performed in 16 cases (combined with axillary nerve reconstruction in 6 upper palsies). Nerve graft was performed in 6 cases.<BR>For elbow reconstruction, intercostal nerve transfer to the motor branch of the biceps muscle was performed in 17 cases. Oberlin procedure (in 9 cases) and partial median nerve transfer (in 3 cases) were performed for upper palsy.<BR>Nerve graft procedures were not satisfactory in shoulder reconstruction. However, accessory nerve transfer with axillary nerve reconstruction achieved favorable results, with muscle strength recovery to MMT 3 or greater in shoulder abduction.<BR>Intercostal nerve transfer achieved favorable result in younger patients.<BR>The Oberlin procedure achieved better elbow function in the short term. However, in C5 - 7 root injury cases, the Oberlin procedure was less effective. Median/ulnar funiculus transfer should be selected following confirmation by electronic stimulation during operation.

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