Data_Sheet_1_Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury.PDF

Introduction: Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries. We here describe our experience in treating such patients and lay out the surgical rational and rehabilitation protocol exemplified in one patient.
Case Presentation/Methods: A 27-year-old adult with a unilateral OBPI contacted our center. He presented with globally diminished function of the affected upper extremity with minimal hand activity, resulting in an inability to perform various tasks of daily living. No biological reconstructive efforts were available to restore meaningful hand function. An interdisciplinary evaluation, including a psychosocial assessment, was used to assess eligibility for bionic reconstruction. Before the amputation and after the prosthetic fitting functional assessments and self-reported questionnaires were performed.
Results: One month after the amputation and de-rotation osteotomy of the humerus the patient was fitted with a myoelectric prosthesis. At the 1.5 year-follow-up assessment, the patient presented with a distinct improvement of function: the ARAT improved from 12 to 20 points, SHAP score improved from 8 to 29, and the DASH value improved from 50 to 11.7. The average wearing times of the prosthesis were 5 to 6 h per day (on 4–5 days a week).
Discussion: The options for adults suffering from the consequences of severe OBPIs to improve function are limited. In selected patients in whom the neurological deficit is so severe that biologic hand function is unsatisfactory, an elective amputation and subsequent restoration of the hand with mechatronic means may be an option. The follow-up results indicate that this concept can indeed lead to solid hand function and independence in daily activities after amputation, subsequent prosthetic fitting, and rehabilitation.

引言：许多罹患Narakas IV型产伤性臂丛神经损伤（obstetric brachial plexus injury, OBPI）的成年患者，因手臂功能受限，存在广泛的日常生活能力障碍。在发育极早期便大幅丧失轴突支持，常导致整个肢体沦为生物学废用状态，而常规重建手术与治疗手段往往无法恢复任何具备实用功能的手部活动。在此类场景下，仿生重建方案——包括选择性截肢及后续假肢装配——或可改善此类重症臂丛神经损伤成年患者的功能状态。本文详述了我们针对此类患者的诊疗经验，并以1例患者为例，阐明了手术原理与康复方案。

病例报告/研究方法：1例27岁单侧产伤性臂丛神经损伤患者就诊于本医疗中心。患者患肢上肢功能全面减退，手部活动度极低，无法完成各类日常工作与生活任务，且暂无有效的生物学重建手段可帮助其恢复具备实用价值的手部功能。我们通过涵盖社会心理评估在内的多学科联合评估，筛选符合仿生重建指征的患者。分别于截肢术前及假肢装配完成后，开展了功能评估与自评问卷调研。

结果：患者接受肱骨旋转截骨术与截肢术后1个月，装配了肌电假肢（myoelectric prosthesis）。在术后1.5年的随访评估中，患者功能获得显著改善：动作研究臂测试（Action Research Arm Test, ARAT）评分从12分提升至20分，SHAP评分从8分提升至29分，臂肩手功能障碍评分（Disabilities of the Arm, Shoulder and Hand, DASH）从50分降至11.7分。患者假肢日均佩戴时长为5~6小时，每周佩戴4~5天。

讨论：针对罹患重症产伤性臂丛神经损伤后遗症的成年患者，可用于改善其功能的治疗选择十分有限。对于神经缺损程度极为严重、无法获得有效手部生物学功能的选定患者，选择性截肢并借助机电一体化手段重建手部功能或为可行方案。随访结果表明，该治疗理念确实可在截肢、后续假肢装配及康复训练后，帮助患者获得稳定的手部功能与日常生活活动独立性。