腕神経叢麻ひに対する肘関節機能再建術

Abstract

Surgical procedures for the elbow flexor restoration in brachial plexus palsy depend on the paralytic status of the patient. 30 elbows of 29 patients were evaluated functionally following flexorplasty. The average age at surgery was 28.2 years (8 to 53 years) with an average follow-up period of 6 years. The procedures included intercostal nerve transfer (18 elbows), Steindler's method (6 elbows), latissimus dorsi transplantation (4 elbows) and pectoralis major transplantation (2 elbows). Bateman's operation in 9 cases and shoulder arthrodesis in 3 cases were carried out to stabilize the shoulder.The elbow flexion strength were evaluated according to Daniel and Worthingham's muscle testing (M0 to M5). With intercostal nerve transfer, MMT improved to M4 in 5 elbows, M3 in 7 elbows and below M3 in 6 elbows at final follow-up.The average active flexion was 115°. 5 elbows had M4 and one M3 and the average active flexion was 104° with St.eindler's method. In patients with latissimus dorsi transplantation, 2 obtained M4 and rest 2 had M3 and M2 each. The average active flexion was 95°. In patients with pectoralis major transplantation, both the cases had M2.From this study it can be suggested that muscle transfer should be considered than intercostal nerve transfer. Our results showed Steindler's method can provide a stable and satisfactory outcome.