Hand function reconstruction by tendon transfers in patients with cervical spinal cord injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LI Jun ^1,2 , DU Liangjie ^1,2 , LIU Hongwei ^1,2 , GAO Feng ^1,2 , LIU Lu ^1,2 , GUO Yun ^1,2 , WANG Chong ^1,2 , YANG Mingliang ^1,2 , LI Jianjun ^1,2 , ZHANG Youle ³

1. Department of Spinal and Neural Functional Reconstruction, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;
2. Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China;
3. Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China;

Corresponding author：

LI Jun, Email: lijun2009crrc@163.com

Keywords：

Tendon transfer; cervical spinal cord injury; reconstruction; hand function

DOI：

10.7507/1002-1892.201711078

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ObjectiveTo explore the effectiveness of functional reconstruction of hand grasp and pinch by tendon transfers in patients with cervical spinal cord injury.MethodsBetween July 2013 and January 2016, tendon transfer surgery were performed in 21 patients (41 hands) with cervical spinal injury that motion level was located at C₆ to reconstruct hand grasp and pinch function. There were 18 males and 3 females with a mean age of 42.3 years (range, 17-65 years). Nineteen patients were with complete spinal cord injury [American Spinal Injury Association (ASIA) grading A], 1 patient was with central cord syndrome whose bilateral hands were completely paralyzed and lower limbs were normal (ASIA grading D), and 1 patient was with cervical spondylotic myelopathy (AISA grading D). The time from injury to hospitalization was 12-22 months (mean, 16.8 months). According to the International classification of surgery of the hand in tetraplegia (ICSHT), there were 6 cases of grade O3, 10 of grade O4, 3 of grade OCu5, and 2 of grade O5. The surgery was divided into two stages with an interval of 6-11 months. At the first stage, grip function was reconstructed in all patients by transfering the extensor carpi radialis longus from radialis side to palmar side through subcutaneous tunnel, and braided and sutured with the flexor pollicis longus and flexor digitorum profundus. At the second stage, the lateral pinch function of the thumb and index finger was reconstructed by braiding and suturing the radial half of the extensor carpi ulnaris (the patients graded as ICSHT O3) or pronator tere (the patients graded above ICSHT O3) with extensor pollicis longus and abductor pollicis longus. The grasp force, the thumb and index finger lateral pinch force, and the maximum fingertips distance between the thumb and index finger were measured at preoperation and at different time points after operation. The modified Lamb and Chan questionnaire, based upon the activities of daily living, was used to evaluate the hand function of all patients at 6 months after sencond stage surgery.ResultsThere was 1 patient with elbow skin lesion, 1 patient with wrist stiffness; both of them recovered after corresponding treatment. All the 21 patients were followed up 15-32 months (mean, 19.6 months) without wound infection, tendon adhesion, tendon rupture, and other complications. The grasp forces of all patients were significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the first stage surgery when compared with preoperative value (P<0.05); and no significant difference was found between different time points after operation (P>0.05). The thumb and index finger lateral pinch force and the maximum fingertips distance between the thumb and index finger of all patients were also significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the second stage surgery when compared with preoperative values (P<0.05); and no significant difference was found between different time points after operation (P>0.05). And there was no significant difference of above indexes between the patients graded as ICSHT O3 and above ICSHT O3 (P>0.05). The functional outcome was good in 19 cases, fair in 1 case, and poor in 1 case according to modified Lamb and Chan questionnaire at 6 months after second stage surgery.ConclusionTendon transfer can significantly improve the hand function and the quality of life of the patients with complete cervical spinal cord injury.

Citation： LI Jun, DU Liangjie, LIU Hongwei, GAO Feng, LIU Lu, GUO Yun, WANG Chong, YANG Mingliang, LI Jianjun, ZHANG Youle. Hand function reconstruction by tendon transfers in patients with cervical spinal cord injury. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(5): 542-547. doi: 10.7507/1002-1892.201711078 Copy

1.	Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 2006, 44(9): 523-529.
2.	Senjaya F, Midha R. Nerve transfer strategies for spinal cord injury. World Neurosurg, 2013, 80(6): e319-326.
3.	郝春霞, 李建军, 周红俊, 等. 1264例住院脊髓损伤患者的流行病学分析. 中国康复理论与实践, 2007, 11(13): 1011-1013.
4.	Anderson KD. Targeting recovery: Priorities of the spinal cord injured population. J Neurotrauma, 2004, 21(10): 1371-1383.
5.	Snoek GJ, Ijzerman MJ, Hermens HJ, et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord, 2004, 42(9): 526-532.
6.	Brown JM, Vivio N, Sheean GL. The clinical practice of reconstructive neurosurgery. Clin Neurol Neurosurg, 2012, 114(5): 506-514.
7.	Curtin CM, Gater DR, Chung KC. Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. J Hand Surg (Am), 2005, 30(1): 94-99.
8.	Anderson KD, Fridén J, Lieber RL. Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. Spinal Cord, 2009, 47(4): 334-338.
9.	Manns PJ, Chad KE. Components of quality of life for persons with a quadriplegic and paraplegic spinal cord injury. Qual Health Res, 2001, 11(6): 795-811.
10.	Hamou C, Shah NR, DiPonio L, et al. Pinch and elbow extension restoration in people with tetraplegia: a systematic review of the literature. J Hand Surg (Am), 2009, 34(4): 692-699.
11.	Curtin CM, Wagner JP, Gater DR, et al. Opinions on the treatment of people with tetraplegia: contrasting perceptions of physiatrists and hand surgeons. J Spinal Cord Med, 2007, 30(3): 256-262.
12.	Dunn JA, Hay-Smith EJ, Whitehead LC, et al. Liminality and decision making for upper limb surgery in tetraplegia: a grounded theory. Disabil Rehabil, 2013, 35(15): 1293-1301.
13.	Chung KC, Lau FH, Kotsis SV, et al. Factors influencing residents’ decisions to pursue a career in hand surgery: a national survey. J Hand Surg (Am), 2004, 29(4): 738-747.
14.	Rothwell AG, Sinnott KA, Mohammed KD, et al. Upper limb surgery for tetraplegia: a 10-year re-review of hand function. J Hand Surg (Am), 2003, 28(3): 489-497.
15.	Mohindra M, Sangwan SS, Kundu ZS, et al. Surgical rehabilitation of a tetraplegic hand: comparison of various methods of reconstructing an absent pinch and hook. Hand (N Y), 2014, 9(2): 179-186.
16.	Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier, 2011: 1119.
17.	Zlotolow DA. The role of the upper extremity surgeon in the management of tetraplegia. J Hand Surg (Am), 2011, 36(5): 929-935.
18.	Curtin CM, Gater DR, Chung KC. Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. J Hand Surg (Am), 2005, 30(1): 94-99.
19.	Fridén J, Gohritz A. Muscle and nerve transfer in tetraplegia. J Neurosurg, 2013, 118(3): 706-707.
20.	Krauss EM, Tung TH, Moore AM. Free functional muscle transfers to restore upper extremity function. Hand Clin, 2016, 32(2): 243-256.
21.	李军, 王冲, 杜良杰, 等. 颈段脊髓损伤患者上肢功能重建手术认知度的问卷调查. 中国康复理论与实践, 2017, 23(2): 217-220.
22.	Fridén J, Gohritz A. Tetraplegia Management Update. J Hand Surg (Am), 2015, 40(12): 2489-2500.
23.	Dunn JA, Rothwell AG, Mohammed KD, et al. The effects of aging on upper limb tendon transfers in patients with tetraplegia. J Hand Surg (Am), 2014, 39(2): 317-323.

1. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord, 2006, 44(9): 523-529.
2. Senjaya F, Midha R. Nerve transfer strategies for spinal cord injury. World Neurosurg, 2013, 80(6): e319-326.
3. 郝春霞, 李建军, 周红俊, 等. 1264例住院脊髓损伤患者的流行病学分析. 中国康复理论与实践, 2007, 11(13): 1011-1013.
4. Anderson KD. Targeting recovery: Priorities of the spinal cord injured population. J Neurotrauma, 2004, 21(10): 1371-1383.
5. Snoek GJ, Ijzerman MJ, Hermens HJ, et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord, 2004, 42(9): 526-532.
6. Brown JM, Vivio N, Sheean GL. The clinical practice of reconstructive neurosurgery. Clin Neurol Neurosurg, 2012, 114(5): 506-514.
7. Curtin CM, Gater DR, Chung KC. Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. J Hand Surg (Am), 2005, 30(1): 94-99.
8. Anderson KD, Fridén J, Lieber RL. Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. Spinal Cord, 2009, 47(4): 334-338.
9. Manns PJ, Chad KE. Components of quality of life for persons with a quadriplegic and paraplegic spinal cord injury. Qual Health Res, 2001, 11(6): 795-811.
10. Hamou C, Shah NR, DiPonio L, et al. Pinch and elbow extension restoration in people with tetraplegia: a systematic review of the literature. J Hand Surg (Am), 2009, 34(4): 692-699.
11. Curtin CM, Wagner JP, Gater DR, et al. Opinions on the treatment of people with tetraplegia: contrasting perceptions of physiatrists and hand surgeons. J Spinal Cord Med, 2007, 30(3): 256-262.
12. Dunn JA, Hay-Smith EJ, Whitehead LC, et al. Liminality and decision making for upper limb surgery in tetraplegia: a grounded theory. Disabil Rehabil, 2013, 35(15): 1293-1301.
13. Chung KC, Lau FH, Kotsis SV, et al. Factors influencing residents’ decisions to pursue a career in hand surgery: a national survey. J Hand Surg (Am), 2004, 29(4): 738-747.
14. Rothwell AG, Sinnott KA, Mohammed KD, et al. Upper limb surgery for tetraplegia: a 10-year re-review of hand function. J Hand Surg (Am), 2003, 28(3): 489-497.
15. Mohindra M, Sangwan SS, Kundu ZS, et al. Surgical rehabilitation of a tetraplegic hand: comparison of various methods of reconstructing an absent pinch and hook. Hand (N Y), 2014, 9(2): 179-186.
16. Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier, 2011: 1119.
17. Zlotolow DA. The role of the upper extremity surgeon in the management of tetraplegia. J Hand Surg (Am), 2011, 36(5): 929-935.
18. Curtin CM, Gater DR, Chung KC. Upper extremity reconstruction in the tetraplegic population, a national epidemiologic study. J Hand Surg (Am), 2005, 30(1): 94-99.
19. Fridén J, Gohritz A. Muscle and nerve transfer in tetraplegia. J Neurosurg, 2013, 118(3): 706-707.
20. Krauss EM, Tung TH, Moore AM. Free functional muscle transfers to restore upper extremity function. Hand Clin, 2016, 32(2): 243-256.
21. 李军, 王冲, 杜良杰, 等. 颈段脊髓损伤患者上肢功能重建手术认知度的问卷调查. 中国康复理论与实践, 2017, 23(2): 217-220.
22. Fridén J, Gohritz A. Tetraplegia Management Update. J Hand Surg (Am), 2015, 40(12): 2489-2500.
23. Dunn JA, Rothwell AG, Mohammed KD, et al. The effects of aging on upper limb tendon transfers in patients with tetraplegia. J Hand Surg (Am), 2014, 39(2): 317-323.

Chinese Journal of Reparative and Reconstructive Surgery

Hand function reconstruction by tendon transfers in patients with cervical spinal cord injury

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