Abstract:
Elbow flexion paralysis is one of most significant deficiencies in the upper limb. When secondary to brachial plexus palsy or nerve trunk lesions, restoration of elbow flexion by means of early nerve surgery or palliative transfers should be part of a comprehensive treatment plan. Tendon transfers are indicated in long-standing palsies, in those who are poor candidates for nerve surgery or when the results of nerve surgery are inadequate. A regional pedicled muscle transfer is performed if available. In this case, a \"strong\" donor is preferred (pectoralis major with pectoralis minor transfer, triceps brachii to biceps brachii transfer, or bipolar latissimus dorsi transfer). A \"weak\" transfer is indicated in patients who have incomplete recovery of elbow flexion (MRC 2 strength): isolated pectoralis minor transfer, medial epicondylar muscle transfer according to Steindler technique, or advancement of biceps brachii tendon on forearm. When no donor muscle is available, a free reinnervated muscle transfer may be indicated if age and nerve regeneration conditions are favorable.
摘要:
肘关节屈曲麻痹是上肢最重要的缺陷之一。当继发于臂丛神经麻痹或神经干病变时,通过早期神经外科手术或姑息性转移恢复肘关节屈曲应成为综合治疗计划的一部分。肌腱转移表现在长期麻痹中,在那些不适合神经外科手术或神经外科手术结果不充分的人中。如果有的话,进行区域性带蒂肌肉转移。在这种情况下,首选“强”捐赠者(胸大肌与胸大肌次要转移,肱三头肌转移到肱二头肌,或双相背阔肌转移)。肘部屈曲不完全恢复(MRC2强度)的患者表示“弱”转移:孤立的胸大肌小转移,根据Steindler技术,内侧上髁肌转移,或前臂肱二头肌肌腱前移。当没有供体肌肉时,如果年龄和神经再生条件有利,则可能需要进行自由的神经支配性肌肉转移。