Abstract
The aim of the work is to objectify the functional effectiveness of these operations and their influence on the quality of life of handicapped patients. The authors evaluate the results of reconstructive surgery restoring hand grip in a group of 15 tetraplegic patients (3 women and 12 men) with complete spinal cord lesion of C5-C7 segments. The average age of patients in the group is 33 (22-50) years old. The reconstructions were performed using tendon transfer and tenodesis in the forearm and hand area. The effectiveness of the transfer was assessed objectively with regard to muscle strength by measuring the restored "thumb-index finger" grip and "into fist" grip. The range of motion achieved was also evaluated. Transfer effectiveness was evaluated on the basis of subjective patients' evaluation. An ADL (activities of daily living) questionnaire by Mohammed's (1992) took into account the effect of the surgery in a whole range of common daily activities. An extended range of daily activities was evident mainly in the fields of: communication, eating and drinking and operations associated with increase in general selfcare of the patient. There was no deterioration of condition in any of the activities. Up to 80 % of tetraplegic patients are suitable candidates for transfers and, to a certain extent, it is possible to improve the upper limb function. In a partial function restoration of the upper limbs there is immense potential for improvement in the quality of life of these patients.
Highlights
Traumatic tetraplegia as a result of a cervical spinal cord lesion above the Th1 segment is mostly irreversible
Muscles innervated above the position of the cervical spinal cord lesion remain active
Classification of muscles suitable for surgical reconstruction of grip and evaluation of an appropriate surgical technique were developed over past decades mainly due to the work of Moberg[16]
Summary
Traumatic tetraplegia as a result of a cervical spinal cord lesion above the Th1 segment is mostly irreversible. It represents a radical change in the life of a patient who is fully dependent on help from others. Their range of daily life activities is significantly limited with regard to the functional inactivity of the upper and lower extremities. Muscles innervated above the position of the cervical spinal cord lesion remain active. Current development unambiguously proceeds with a quantitative increase in active muscle transfers, considerable transfer of paralyzed muscles to balance creation and possibly the application of electronics for paralyzed muscle control
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