Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct re...Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system;meaningful recovery was defined as M3–M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID:[2017] 290) on November 14, 2017.展开更多
目的探讨功能促进型护理方案对提高肘关节骨折术患者临床疗效的应用分析。方法采用回顾性研究,便利抽样法选取我院2021年01月-2022年12月期间100例肘关节骨折患者为对象,随机分为常规组(50例)和促进组(50例)。常规组给予常规护理干预,...目的探讨功能促进型护理方案对提高肘关节骨折术患者临床疗效的应用分析。方法采用回顾性研究,便利抽样法选取我院2021年01月-2022年12月期间100例肘关节骨折患者为对象,随机分为常规组(50例)和促进组(50例)。常规组给予常规护理干预,促进组在此基础上给予基于功能促进型护理方案干预,观察并比较两组患者干预前后的肘关节功能以及临床疗效。结果实施功能促进型护理方案干预后,促进组肘关节功能评分均高于常规组,促进组关节活动度(Range of Motion,ROM)中屈曲、旋前、旋后评分高于常规组,ROM关节活动度中背伸评分低于常规组(P<0.05);促进组临床疗效优于常规组(P<0.05)。结论功能促进型护理方案干预可显著提升肘关节骨折术患者肘关节功能水平,改善活动功能,降低疼痛,可广泛应用和推广。展开更多
基金supported by the National Natural Science Foundation of China,No.81572130(to LQG)and 81601057(to JTY)the National Key Research and Development Plan of China,No.2016YFC1101603(to XLL)the Natural Science Foundation of Guangdong Province of China,No.2015A030310350(to JTY)
文摘Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system;meaningful recovery was defined as M3–M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID:[2017] 290) on November 14, 2017.
文摘目的探讨功能促进型护理方案对提高肘关节骨折术患者临床疗效的应用分析。方法采用回顾性研究,便利抽样法选取我院2021年01月-2022年12月期间100例肘关节骨折患者为对象,随机分为常规组(50例)和促进组(50例)。常规组给予常规护理干预,促进组在此基础上给予基于功能促进型护理方案干预,观察并比较两组患者干预前后的肘关节功能以及临床疗效。结果实施功能促进型护理方案干预后,促进组肘关节功能评分均高于常规组,促进组关节活动度(Range of Motion,ROM)中屈曲、旋前、旋后评分高于常规组,ROM关节活动度中背伸评分低于常规组(P<0.05);促进组临床疗效优于常规组(P<0.05)。结论功能促进型护理方案干预可显著提升肘关节骨折术患者肘关节功能水平,改善活动功能,降低疼痛,可广泛应用和推广。
