Abstract：
OBJECTIVE: Traumatic brachial plexus injury (BPI) is a high-morbidity condition with an escalating incidence. One of the treatment options is neurotization using the ipsilateral phrenic nerve. Therefore, diagnosis of nerve dysfunction is a crucial step in preoperative planning. This study aimed to assess the accuracy and reliability of the fluoroscopic sniff test for preoperative diagnosis of phrenic nerve injury in patients with traumatic BPI.
METHODS: The study was conducted from June 2019 to August 2023 at a tertiary care hospital. A preoperative fluoroscopic sniff test was performed. During brachial plexus surgery, direct phrenic nerve stimulation was conducted as a gold standard of phrenic nerve function. Two nonoperating orthopedic surgeons interpreted the accuracy and reliability of the test.
RESULTS: Seventy-four patients with traumatic BPI (66 males and 8 females) with a median age of 26 years were enrolled. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the fluoroscopic sniff test were 90.9% (95% CI 75.7%-98.1%), 100% (95% CI 91.4%-100%), 100% (95% CI 88.4%-100%), 93.2% (95% CI 82.3%-97.6%), and 95.9% (95% CI 88.6%-99.2%), respectively. Interobserver reliability showed excellent agreement (κ = 1, p < 0.001).
CONCLUSIONS: The fluoroscopic sniff test was proven to be an accurate, reliable, and simple tool to evaluate phrenic nerve function in patients with traumatic BPI. Preoperative testing should be performed to reduce operative time to identify the phrenic nerve as a donor for nerve transfer surgery in cases in which no function is detected from the fluoroscopic sniff test.
METHODS: The study was conducted from June 2019 to August 2023 at a tertiary care hospital. A preoperative fluoroscopic sniff test was performed. During brachial plexus surgery, direct phrenic nerve stimulation was conducted as a gold standard of phrenic nerve function. Two nonoperating orthopedic surgeons interpreted the accuracy and reliability of the test.
RESULTS: Seventy-four patients with traumatic BPI (66 males and 8 females) with a median age of 26 years were enrolled. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the fluoroscopic sniff test were 90.9% (95% CI 75.7%-98.1%), 100% (95% CI 91.4%-100%), 100% (95% CI 88.4%-100%), 93.2% (95% CI 82.3%-97.6%), and 95.9% (95% CI 88.6%-99.2%), respectively. Interobserver reliability showed excellent agreement (κ = 1, p < 0.001).
CONCLUSIONS: The fluoroscopic sniff test was proven to be an accurate, reliable, and simple tool to evaluate phrenic nerve function in patients with traumatic BPI. Preoperative testing should be performed to reduce operative time to identify the phrenic nerve as a donor for nerve transfer surgery in cases in which no function is detected from the fluoroscopic sniff test.
摘要：
目的：创伤性臂丛神经损伤（BPI）是一种发病率较高的疾病，发病率不断上升。治疗选择之一是使用同侧膈神经的神经化。因此,神经功能障碍的诊断是术前计划的关键步骤。本研究旨在评估透视嗅探测试术前诊断创伤性BPI患者膈神经损伤的准确性和可靠性。
方法：该研究于2019年6月至2023年8月在一家三级保健医院进行。进行了术前荧光镜嗅探测试。在臂丛手术期间，直接膈神经刺激作为膈神经功能的金标准。两名非手术整形外科医生解释了测试的准确性和可靠性。
结果：纳入74例创伤性BPI患者（男66例，女8例），中位年龄26岁。灵敏度,特异性，正预测值，负预测值，透视嗅探测试的准确性为90.9%(95%CI75.7%-98.1%)，100%（95%CI91.4%-100%），100%（95%CI88.4%-100%），93.2%（95%CI82.3%-97.6%），和95.9%（95%CI88.6%-99.2%），分别。观察者间可靠性表现出极好的一致性(κ=1，p<0.001)。
结论：荧光嗅探测试被证明是准确的，可靠,评估创伤性BPI患者膈神经功能的简单工具。在荧光镜嗅探测试未检测到功能的情况下，应进行术前测试以减少手术时间，以将the神经识别为神经转移手术的供体。
方法：该研究于2019年6月至2023年8月在一家三级保健医院进行。进行了术前荧光镜嗅探测试。在臂丛手术期间，直接膈神经刺激作为膈神经功能的金标准。两名非手术整形外科医生解释了测试的准确性和可靠性。
结果：纳入74例创伤性BPI患者（男66例，女8例），中位年龄26岁。灵敏度,特异性，正预测值，负预测值，透视嗅探测试的准确性为90.9%(95%CI75.7%-98.1%)，100%（95%CI91.4%-100%），100%（95%CI88.4%-100%），93.2%（95%CI82.3%-97.6%），和95.9%（95%CI88.6%-99.2%），分别。观察者间可靠性表现出极好的一致性(κ=1，p<0.001)。
结论：荧光嗅探测试被证明是准确的，可靠,评估创伤性BPI患者膈神经功能的简单工具。在荧光镜嗅探测试未检测到功能的情况下，应进行术前测试以减少手术时间，以将the神经识别为神经转移手术的供体。
