Abstract:
Palliative tendon transfer is an integral part of radial nerve palsy treatment. It can be considered in the first weeks when the possibility of nerve repair by direct suture or nerve grafting is not feasible or reasonable. Mostly, it is discussed secondarily when it is too late for nerve surgery and motor recovery cannot be expected, or after failure or incomplete recovery after nerve repair. The goal of tendon transfers is to restore wrist, finger and thumb extension. For wrist extension, the use of pronator teres is well accepted. The best tendon transfer for finger extension is debated. This can be restored doing a flexor carpi ulnaris (FCU), flexor carpi radialis or flexor digitorum superficialis (FDS) to extensor digitorum communis transfer. Regarding thumb extension and abduction, a palmaris longus (PL) or one FDS tendon to the rerouted extensor pollicis longus (EPL) transfer can be performed. If a transfer is done on the EPL without rerouting it, abduction can be restored by doing a tendon transfer to the abductor pollicis longus (APL) or an APL tenodesis. The different tendon transfer options are selected based on the surgeon\'s preference, and most importantly, discussed with the patients to define the objectives together. The transfer is chosen based on the clinical examination (high or low radial nerve palsy, tendon available for transfer like PL, wrist mobility) and based on the patient\'s needs and expectations (activities requiring the FCU, finger independence, independence of thumb extension or abduction). If the surgical rules and the postoperative instructions for rehabilitation are followed, tendon transfers for radial nerve palsy regularly produce very satisfactory results.
摘要:
姑息性肌腱转移是the神经麻痹治疗不可或缺的一部分。当通过直接缝合或神经移植进行神经修复的可能性不可行或不合理时,可以在最初几周考虑。大多数情况下,其次,当神经外科手术为时已晚并且无法预期运动恢复时,或神经修复后失败或不完全恢复。肌腱转移的目标是恢复手腕,手指和拇指延伸。对于手腕伸展,使用旋前字符是公认的。手指伸展的最佳肌腱转移存在争议。这可以恢复做一个屈肌尺侧腕(FCU),桡侧腕屈肌或指浅屈肌(FDS)向指伸肌转移。关于拇指伸展和外展,可以进行掌长(PL)或一条FDS肌腱到重新路由的伸肌(EPL)转移。如果在EPL上完成传输而没有重新路由,可以通过将肌腱转移到长肌腱(APL)或APL肌腱固定术来恢复外展。根据外科医生的偏好选择不同的肌腱转移选项,最重要的是,与患者一起讨论以确定目标。根据临床检查(高或低radial神经麻痹,肌腱可用于转移,如PL,手腕活动),并根据患者的需求和期望(需要FCU的活动,手指独立性,拇指伸展或外展的独立性)。如果遵循手术规则和术后康复指导,radium神经麻痹的肌腱转移定期产生非常令人满意的结果。