Background: 

A cohort of patients with traumatic brachial plexus injuries (BPIs) underwent elective amputation following unsuccessful surgical reconstruction or delayed presentation. The results of amputation with and without a myoelectric prosthesis (MEP) using nonintuitive controls were compared. We sought to determine the benefits of amputation, and whether fitting with an MEP was feasible and functional.

Methods: 

We conducted a retrospective review of patients with BPI who underwent elective upper-extremity amputation at a single institution. Medical records were reviewed for demographics, injury and reconstruction details, amputation characteristics, outcomes, and complications. Prosthesis use and MEP function were assessed. The minimum follow-up for clinical outcomes was 12 months.

Results: 

Thirty-two patients with BPI and an average follow-up of 53 months underwent elective amputation between June 2000 and June 2020. Among the cases were 18 transhumeral amputations, 12 transradial amputations, and 2 wrist disarticulations. There were 29 pan-plexus injuries, 1 partial C5-sparing pan-plexus injury, 1 lower-trunk with lateral cord injury, and 1 lower-trunk injury. Amputation occurred, on average, at 48.9 months following BPI and 36.5 months following final reconstruction. Ten patients were fitted for an MEP with electromyographic signal control from muscles not normally associated with the intended function (nonintuitive control). Average visual analog scale pain scores decreased post-amputation: from 4.8 pre-amputation to 3.3 for the MEP group and from 5.4 to 4.4 for the non-MEP group. Average scores on the Disabilities of the Arm, Shoulder and Hand questionnaire decreased post-amputation, but not significantly: from 35 to 30 for the MEP group and from 43 to 40 for the non-MEP group. Patients were more likely to be employed following amputation than they were before amputation. No patient expressed regret about undergoing amputation. All patients in the MEP group reported regular use of their prosthesis compared with 29% of patients with a traditional prosthesis. All patients in the MEP group demonstrated functional terminal grasp/release that they considered useful.

Conclusions: 

Amputation is an effective treatment for select patients with BPI for whom surgical reconstruction is unsuccessful. Patients who underwent amputation reported decreased mechanical pain, increased employment rates, and a high rate of satisfaction following surgery. In amputees with sufficient nonintuitive electromyographic signals, MEPs allow for terminal grasp/release and are associated with high rates of prosthesis use.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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截肢和肌电假肢在外伤性臂丛损伤患者中的作用

背景： 

一组患有创伤性臂丛神经损伤 (BPI) 的患者在手术重建失败或延迟就诊后接受了选择性截肢。比较了使用非直观控制的有和没有肌电假体 (MEP) 的截肢结果。我们试图确定截肢的好处，以及与 MEP 配合是否可行和有效。

方法： 

我们对在单一机构接受选择性上肢截肢的 BPI 患者进行了回顾性研究。对医疗记录进行了人口统计、损伤和重建细节、截肢特征、结果和并发症的审查。评估了假体的使用和 MEP 功能。临床结果的最短随访时间为 12 个月。

结果： 

2000 年 6 月至 2020 年 6 月期间，32 名 BPI 患者平均随访 53 个月接受了择期截肢。其中经肱骨截肢 18 例，经桡动脉截肢 12 例，腕关节脱位 2 例。泛丛损伤29例，保留C5的部分泛丛损伤1例，下躯干外侧脊髓损伤1例，下躯干损伤1例。平均而言，截肢发生在 BPI 后 48.9 个月和最终重建后 36.5 个月。10 名患者接受了 MEP，其肌电信号控制来自通常与预期功能无关的肌肉（非直观控制）。平均视觉模拟量表疼痛评分在截肢后降低：MEP 组从截肢前的 4.8 降低到 3.3，非 MEP 组从截肢前的 5.4 降低到 4.4。手臂残疾的平均分，肩部和手部问卷在截肢后减少，但不显着：MEP 组从 35 到 30，非 MEP 组从 43 到 40。与截肢前相比，截肢后患者更有可能被雇用。没有患者对截肢表示遗憾。MEP 组的所有患者都报告定期使用他们的假肢，而使用传统假肢的患者比例为 29%。MEP 组中的所有患者都表现出他们认为有用的功能性末端抓握/释放。MEP 组的所有患者都报告定期使用他们的假肢，而使用传统假肢的患者比例为 29%。MEP 组中的所有患者都表现出他们认为有用的功能性末端抓握/释放。MEP 组的所有患者都报告定期使用他们的假肢，而使用传统假肢的患者比例为 29%。MEP 组中的所有患者都表现出他们认为有用的功能性末端抓握/释放。

结论： 

对于手术重建不成功的部分 BPI 患者，截肢是一种有效的治疗方法。接受截肢的患者报告说机械性疼痛减少，就业率增加，手术后满意度高。在具有足够非直观肌电信号的截肢者中，MEP 允许末端抓握/释放，并且与假体使用率高相关。

证据等级： 

治疗三级。有关证据级别的完整描述，请参见作者说明。