Background

Acute flaccid myelitis (AFM) is a rare disease of young children. The typical presentation involves acute-onset flaccid paralysis in one or more extremities with a nonspecific viral prodrome. Long-term outcomes demonstrate that functional recovery plateaus around six to nine months. The purpose of this study was to evaluate the efficacy of nerve transfers for restoring shoulder function in these patients.

Methods

A retrospective review of all patients diagnosed with AFM at a single institution. Shoulder function was evaluated using the active movement scale (AMS). Children at a minimum of six months after diagnosis with plateaued shoulder AMS scores of 4 or less were indicated for surgery.

Results

Eleven patients were identified with a mean time from symptom onset to surgery of 12 months. Average follow-up was 19 months. The mean AMS score at follow-up for shoulder external rotation and abduction was 4.6 and 2.8, respectively. A total of six different nerve transfers with five different donor nerves were used individually or in conjunction with each other. The most common transfers were from the spinal accessory nerve to the suprascapular nerve (n = 8) and from the intercostal nerves ×3 to the axillary nerve (n = 5). Patients who received a transfer from the radial nerve to the axillary nerve (n = 2) had the best functional returns, with the mean AMS score of 6.5 in both external rotation and abduction at follow-up.

Conclusion

Nerve transfer procedures may help restore shoulder function in the setting of AFM. Combination procedures that involve a transfer from the radial nerve to the axillary nerve may provide the best functional results.

中文翻译：

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利用神经移植重建急性弛缓性脊髓炎时的肩部功能：单机构研究。

背景

急性弛缓性脊髓炎（AFM）是幼儿的罕见疾病。典型的表现包括一个或多个非特异性病毒前体的急性发作性弛缓性麻痹。长期结果表明，功能恢复期在六至九个月左右。这项研究的目的是评估这些患者中神经转移对恢复肩部功能的功效。

方法

对单个机构中所有诊断出患有AFM的患者进行回顾性回顾。使用主动运动量表（AMS）评估肩部功能。在诊断后至少六个月内，肩部AMS评分稳定在4分或以下的儿童需要进行手术。

结果

确定了11名患者，从症状发作到手术的平均时间为12个月。平均随访19个月。随访中，肩关节外旋和外展的平均AMS评分分别为4.6和2.8。总共使用了六种不同的神经传递方式，分别使用了五种不同的供体神经，或者彼此结合使用。最常见的转移是从脊椎副神经到肩cap上神经（n = 8）和从肋间神经×3到腋窝神经（n = 5）的转移。从the神经转移到腋神经（n = 2）的患者的功能恢复最好，外旋和外展时AMS平均评分为6.5。

结论

神经转移程序可能有助于恢复AFM设置中的肩部功能。涉及从the神经转移到腋神经的联合手术可能会提供最佳的功能结果。