- 著者
-
普天間 朝上
金城 政樹
大久保 宏貴
仲宗根 素子
川越 得弘
金谷 文則
- 出版者
- 日本マイクロサージャリー学会
- 雑誌
- 日本マイクロサージャリー学会会誌
- 巻号頁・発行日
- vol.30, no.4, pp.167-173, 2017
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.