Aim

We report the comparative results of functional upper extremity surgery plans in patients with tetraplegia, including restoration of elbow extension and construction of a key grip in a “one-stage” or “two-stage” operation.

Materials and methods

A series of 36 patients with tetraplegia, with a total of 45 operated upper limbs, was analyzed retrospectively with a mean follow-up of 23 months (13–39 months). We evaluated the analytical strength of elbow extension using the MRC (Medical Research Council) score, the strength of the key grip (kg/F) as well as the autonomy of the patients using functional scores; Lamb (/100) and QIF (Quadriplegia Index of Function) (/100).

Results

Sixteen upper limbs were included in the “one-stage” group and 29 in the “two-stage” group. The groups were comparable preoperatively. Elbow extension strength was 3.6/5 in the one-stage group versus 3.7/5, p = 0.74. Grip strength was 1.8 kg/F in the one-stage group versus 1.3 kg/F, p = 0.22. Regarding the functional scores, there was no statistically significant difference between the two groups for the Lamb score (p = 0.46) and the QIF (p = 0.42). There was no statistically significant difference in terms of the frequency of complications for the elbow (p = 0.49) and for the hand (p = 0.17). The total duration of the one-stage surgery plan averaged 7.5 months compared to 24.7 months for the two-stage plan, p < 0.01. The mean follow-up for the one-stage group was 21 months versus 24 months for the two-stage group.

Conclusion

The results of both plans are similar and indicate that the “one-stage” plan is a reliable option. This all-in-one surgical option reduces postoperative follow-up and dropout rates for patients during the plan timeframe.

Level of evidence

IV; retrospective clinical series.

中文翻译：

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四肢瘫痪患者肘部伸展的恢复和“关键握力”的构建。一期或二期手术方案的比较研究

目的

我们报告了四肢瘫痪患者功能性上肢手术计划的比较结果，包括在“一阶段”或“两阶段”手术中恢复肘部伸展和构建关键握把。

材料和方法

对 36 名四肢瘫痪患者（总共 45 名接受过手术的上肢）进行回顾性分析，平均随访时间为 23 个月（13-39 个月）。我们使用MRC（医学研究委员会）评分来评估肘部伸展的分析强度、关键握力的强度（kg/F）以及使用功能评分来评估患者的自主性；Lamb (/100) 和 QIF（四肢瘫痪功能指数）(/100)。

结果

“一期”组包括 16 个上肢，“两期”组包括 29 个上肢。各组术前具有可比性。一阶段组的肘部伸展强度为 3.6/5，而一阶段组为 3.7/5 ，p  =  0.74。 单阶段组的握力为 1.8 kg/F，而单阶段组为 1.3  kg/F，p  =  0.22。关于功能评分，两组之间的 Lamb 评分 ( p  =  0.46) 和 QIF ( p  =  0.42) 没有统计学上的显着差异。肘部 ( p  =  0.49) 和手部 ( p  =  0.17) 并发症的发生频率没有统计学上的显着差异。一阶段手术计划的总持续时间平均为 7.5 个月，而两阶段计划的总持续时间为 24.7 个月，p  <  0.01。一阶段组的平均随访时间为 21 个月，而两阶段组的平均随访时间为 24 个月。

结论

两个计划的结果相似，表明“一步”计划是一个可靠的选择。这种一体化手术选择减少了患者在计划时间内的术后随访和退出率。

证据级别

四、回顾性临床系列。