Injured metamere and functional surgery of the tetraplegic upper limb

被引:53
作者
Coulet, B [1 ]
Allieu, Y
Chammas, M
机构
[1] Univ Montpellier, Lapeyronie Hosp, Sch Med, Peopara Ctr,Dept Orthopaed & Upper Limb Surg, F-34295 Montpellier 5, France
[2] CHU Lapeyronie, Serv Chirurg Orthoped, F-34295 Montpellier, France
关键词
D O I
10.1016/S0749-0712(02)00020-3
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Functional surgery of the tetraplegic upper limb usually involves the functioning muscles only. Unfortunately, with the emergence of higher-level tetraplegia, the number of paralyzed muscles increases proportionally, giving tetraplegia its specificity. These patients present two different types of paralyzed muscles depending on the status of the lower motor neuron (LMN). With LMN integrity, the muscle is able to be stimulated and still retains some tone (as with central palsy). When the LMN is damaged, however, the muscle is hypotonic and cannot be stimulated (as with peripheral palsy). Functional electrical stimulation [1,2] first demonstrated the ability to assess LMN integrity in patients with high levels of tetraplegia. In mid-and high-level tetraplegia, the proportion of paralyzed muscle with intact LMN is variable [3]. This variability can explain the different clinical presentations in patients with the same neurologic level. The aim of this chapter is to emphasize the size variability of the injured metamere (IM) and to explore its influence on the clinical presentation of and the indications for functional surgery of the upper limb.not produce immediately the full scope of the eventual neurologic impairment. Swelling secondary to the following conditions potentially contributes to the overall extent of spinal damage [4-6]: Edema Venous stasis Spinal venous infarction Compromise of blood supply The release or activation of excitotoxins, lipases, free radicals, and other injurious biochemical substances Indeed, such secondary changes may cause most of the impairment. The size of IM correlates directly with the primary injury (eg, vertebral fracture, gun shot wound) and the secondary swelling. The size variability of the lesional medullary segment can be explained by the combination of these two factors. Thus, patients who have the same neurologic level can present with different IM sizes according to the type of vertebral lesion, the delay until stabilization, and the patient's own physiologic characteristics.
引用
收藏
页码:399 / +
页数:15
相关论文
共 23 条
[1]  
Allieu Y, 1993, Ann Chir Plast Esthet, V38, P180
[2]  
Allieu Y, 2000, Tech Hand Up Extrem Surg, V4, P50, DOI 10.1097/00130911-200003000-00008
[3]  
Allieu Y, 2000, Tech Hand Up Extrem Surg, V4, P64, DOI 10.1097/00130911-200003000-00009
[4]  
Berman SA, 1996, MUSCLE NERVE, V19, P701, DOI 10.1002/(SICI)1097-4598(199606)19:6<701::AID-MUS3>3.0.CO
[5]  
2-E
[6]   Neurographic assessment of intramedullary motoneurone lesions in cervical spinal cord injury: Consequences for hand function [J].
Curt, A ;
Dietz, V .
SPINAL CORD, 1996, 34 (06) :326-332
[7]   EFFECT OF IMPACT TRAUMA ON NEUROTRANSMITTER AND NONNEUROTRANSMITTER AMINO-ACIDS IN RAT SPINAL-CORD [J].
DEMEDIUK, P ;
DALY, MP ;
FADEN, AI .
JOURNAL OF NEUROCHEMISTRY, 1989, 52 (05) :1529-1536
[8]  
FLANDERS AE, 1996, RADIOLOGY, V201, P617
[9]   ONE-STAGE KEY PINCH AND RELEASE WITH THUMB CARPAL-METACARPAL FUSION IN TETRAPLEGIA [J].
HOUSE, JH ;
COMADOLL, J ;
DAHL, AL .
JOURNAL OF HAND SURGERY-AMERICAN VOLUME, 1992, 17A (03) :530-538
[10]  
HOUSE JH, 1985, CLIN ORTHOP RELAT R, P117