Транспозиция нервов у детей с острыми вялыми миелитами для восстановления функции верхней конечности (обзор литературы)

Термин «острый вялый миелит» используется для описания состояния, характеризующегося остро возникшим вялым параличом конечности, а также поражением двигательных нейронов спинного мозга. Отсутствие специфического лечения, тяжелый неврологический дефицит, сохраняющийся у 75–95 % пациентов в отдаленные сроки после перенесенного заболевания, свидетельствуют о его тяжести.

Цель работы – представить современные данные об остром вялом миелите у детей, методах его лечения, а также оценить эффективность транспозиции нервов для восстановления функции верхней конечности.

Поиск публикаций осуществлялся в базах данных PubMed/MEDLINE, Google Scholar за период 2003–2022 гг., также использовались данные Центра по контролю и профилактике болезней США (https://www.cdc.gov). Был проанализирован опыт хирургического лечения 57 детей с парезами верхних конечностей вследствие острого вялого миелита, которым была выполнена транспозиция 105 нервов. Восстановление функции плечевого сустава (невротизация n. axillaris, n. suprascapularis) проводилось у 57 (54,3 %) пациентов, восстановление сгибания предплечья (невротизация n. musculocutaneus) – у 37 (35,2 %), восстановление разгибания предплечья – у 9 (8,5 %) (невротизация ветви n. radialis к m. triceps brachii), улучшение функции сгибателей пальцев кисти – у 1 (1 %) (невротизация ветви n. interosseus anterior), восстановление разгибания пальцев кисти – у 1 (1 %) (невротизация n. interosseus posterior).

Представленный обзор литературы показал эффективность транспозиции нервов у детей с парезами верх‑ них конечностей вследствие острого вялого миелита в сроки до 1 года от начала болезни. При планировании этапности операций приоритеты следует отдавать восстановлению функции плечевого сустава в связи с высокой вероятностью спонтанного восстановления сгибания в локтевом суставе у детей.

1. Hardy D., Hopkins S. Update on acute flaccid myelitis: Recognition, reporting, aetiology and outcomes. Arch Dis Child 2020;105(9):842–47. DOI: 10.1136/archdischild-2019-316817

2. Sousa I.P. Jr., Burlandy F.M., Oliveira S.S. et al. Acute flaccid paralysis laboratorial surveillance in a polio-free country: Brazil, 2005-2014. Hum Vaccin Immunother 2017;13(3):717–23. DOI: 10.1080/21645515.2016.1236164.

3. Lubelski D., Pennington Z., Tuffaha S. et al. Sciatic-to-femoral nerve end-to-end coaptation for proximal lower extremity function in patients with acute flaccid myelitis: technical note and review of the literature. Oper Neurosurg (Hagerstown) 2021;21(1):20–6. DOI: 10.1093/ons/opab057

4. Messacar K., Schreiner T.L., Van Haren K. et al. Acute flaccid myelitis: A clinical review of US cases 2012–2015. Ann Neurol 2016;80(3):326–38. DOI: 10.1002/ana.24730

5. Centers for Disease Control (CDC) and Prevention. Acute Flaccid Myelitis (AFM). Available at: https://www.cdc.gov/acute-flaccidmyelitis/cases-in-us.html.

6. Messacar K., Asturias E.J., Hixon A.M. et al. Enterovirus D68 and acute flaccid myelitis-evaluating the evidence for causality. Lancet Infect Dis 2018;18(8):e239–e247. DOI: 10.1016/S1473-3099(18)30094-X

7. Dyda A., Stelzer-Braid S., Adam D. et al. The association between acute flaccid myelitis (AFM) and enterovirus D68 (EV-D68) – what is the evidence for causation? Euro Surveill 2018;23(3):17–00310. DOI: 10.2807/1560-7917.ES.2018.23.3.17-00310.

8. Knoester M., Helfferich J., Poelman R. et al. 2016 EV-D68 AFM Working Group. Twenty-nine Cases of Enterovirus-D68-associated Acute Flaccid Myelitis in Europe 2016: A Case Series and Epidemiologic Overview. Pediatr Infect Dis J 2019;38(1):16–21. DOI: 10.1097/INF.0000000000002188

9. Carballo C.M., Erro M.G., Sordelli N. et al. Acute flaccid myelitis associated with enterovirus D68 in children, Argentina, 2016. Emerg Infect Dis 2019;25(3):573–6. DOI: 10.3201/eid2503.170897

10. Murphy O.C., Messacar K., Benson L. et al. Acute flaccid myelitis: cause, diagnosis, and management. Lancet 2021;23;397(10271): 334–46. DOI: 10.1016/S0140-6736(20)32723-9

11. Al Awaidy S.T., Khamis F. Wild poliovirus type 1 in Oman: A re-emerging threat that requires urgent, targeted and strategic preparedness. Sultan Qaboos Univ Med J 2020;20(1):e1–e4. DOI: 10.18295/squmj.2020.20.01.001

12. Fomban Leke R.G., King A., Pallansch M.A. et al. Certifying the inter ruption of wild poliovirus transmission in the WHO African region on the turbulent journey to a polio-free world. Lancet Global Health 2020;8(10):e1345–e1351. DOI: 10.1016/s2214-109x(20)30382-x

13. Africa Regional Commission for the Certification of Poliomyelitis Eradication. Certifying the interruption of wild poliovirus transmission in the WHO African region on the turbulent journey to a polio-free world. Lancet 2020;8(10):e1345–e1351. DOI: 10.1016/S2214-109X(20)30382-X

14. Heise C.O., de Oliveira A.J., Bhering T. et al. Nerve transfers for acute flaccid myelitis: A case series. Childs Nerv Syst 2021;37(1):211–5. DOI: 10.1007/s00381-020-04773-6

15. Funahashi S., Nagano A., Sano M. et al. Restoration of shoulder function and elbow flexion by nerve transfer for poliomyelitis-like paralysis caused by enterovirus 71 infection. J Bone Joint Surg Br 2007;89(2):246–8. DOI: 10.1302/0301-620X.89B2.18348

16. Liao H.T., Chuang D.C., Ulusal A.E., Schrag C. Surgical strategies for brachial plexus polio-like paralysis. Plast Reconstr Surg 2007;120(2):482–93. DOI: 10.1097/01.prs.0000267420.76840.5f

17. Pino P.A., Intravia J., Kozin S.H., Zlotolow D.A. Early results of nerve transfers for restoring function in severe cases of acute flaccid myelitis. Ann Neurol 2019;86(4):607–15. DOI: 10.1002/ana.25558.

18. Doi K., Sem S.H., Hattori Y. et al. Surgical reconstruction for upper-extremity paralysis following acute flaccid myelitis. JB JS Open Access 2019;4(4):e0030. DOI: 10.2106/JBJS.OA.19.00030

19. Saltzman E.B., Rancy S.K., Sneag D.B. et al. Nerve transfers for enterovirus d68-associated acute flaccid myelitis: A case series. Pediatr Neurol 2018;88:25–30. DOI: 10.1016/j.pediatrneurol.2018.07.018

20. Rabinovich R.V., Pino P.A., Aversano M. et al. nerve transfers for restoration of elbow flexion in patients with acute flaccid myelitis. J Hand Surg Am. 2022;47(1):91.e1–91.e8. DOI: 10.1016/j.jhsa.2021.02.029

21. Texakalidis P., Xenos D., Murthy N.K. et al. Upper extremity nerve transfers for acute flaccid myelitis: A systematic literature review. Childs Nerv Syst 2022;38(3):521–6. DOI: 10.1007/s00381-021-05419-x

22. Sun S., Bian L., Gao F. et al. A neonatal mouse model of enterovirus D68 infection induces both interstitial pneumonia and acute flaccid myelitis. Antiviral Res 2019;161:108–15. DOI: 10.1016/j.antiviral.2018.11.013

23. Hixon A.M., Yu G., Leser J.S. et al. A mouse model of paralytic myelitis caused by enterovirus D68. PLoS Pathog 2017;13(2):e1006199. DOI: 10.1371/journal.ppat.1006199

24. Messacar K., Sillau S., Hopkins S.E. et al. Safety, tolerability, and efficacy of fluoxetine as an antiviral for acute flaccid myelitis. Neurology 2019;92(18):e2118–e2126. DOI: 10.1212/WNL.0000000000006670

25. Elrick M.J., Gordon-Lipkin E., Crawford T.O. et al. Clinical subpopulations in a sample of North American children diagnosed with acute flaccid myelitis, 2012–2016. JAMA Pediatr 2019;173:134. DOI:10.1001/jamapediatrics.2018.4890

26. Kane M.S., Sonne C., Zhu S. et al. Incidence, risk factors and outcomes among children with acute flaccid myelitis: A population-based cohort study in a california health network between 2011 and 2016. Pediatr Infect Dis J 2019;38(7):667–72. DOI: 10.1097/INF.0000000000002276

27. Dinov D., Donowitz J.R. Acute flaccid myelitis a review of the literature. Front Neurol 2022;13:1034607. DOI: 10.3389/fneur.2022.1034607

28. Helfferich J., Knoester M., Van Leer-Buter C.C. et al. Acute flaccid myelitis and enterovirus D68: Lessons from the past and present. Eur J Pediatr 2019;78:1305–15. DOI: 10.1007/s00431-019-03435-3

29. Gordon-Lipkin E., Muñoz L.S., Klein J.L. et al. Comparative quantitative clinical, neuroimaging, and functional profiles in children with acute flaccid myelitis at acute and convalescent stages of disease. Dev Med Child Neurol 2019;61:366–75. DOI: 10.1111/dmcn.14030

30. Chong P.F., Kira R., Mori H. et al. Acute flaccid myelitis collaborative study investigators. clinical features of acute flaccid myelitis temporally associated with an enterovirus d68 outbreak: Results of a nationwide survey of acute flaccid paralysis in Japan, August– December 2015. Clin Infect Dis 2018;66(5):653–64. DOI: 10.1093/cid/cix860

31. Hopkins S.E. Acute flaccid myelitis: Etiologic challenges, diagnostic and management considerations. Curr Treat Options Neurol 2017;19(12):48. DOI: 10.1007/s11940-017-0480-3

32. Yea C., Bitnun A., Robinson J. et al. Longitudinal outcomes in the 2014 acute flaccid paralysis cluster in Canada. J Child Neurol 2017;32(3):301–7. DOI: 10.1177/0883073816680770

33. McLaren N., Lopez A., Kidd S. et al. Characteristics of patients with acute flaccid myelitis, United States, 2015–2018. Emerg Infect Dis 2020;26(2):212–9. DOI: 10.3201/eid2602.191453

34. Liao H.T., Chuang D.C., Ulusal A.E., Schrag C. Surgical strategies for brachial plexus polio-like paralysis. Plast Reconstr Surg 2007;120(2):482–93. DOI: 10.1097/01.prs.0000267420.76840.5f

35. Ochiai N., Matsumoto Y., Hara Y. et al. For how long do denervated muscles in children retain the ability to regenerate? Restoration of elbow flexion and shoulder function by partial nerve transfer in a child with long-standing poliomyelitis-like paralysis. J Orthop Sci 2019;24(2):195–9. DOI: 10.1016/j.jos.2018.10.014

36. Messacar K., Spence-Davizon E., Osborne C. et al. Clinical charac teristics of enterovirus A71 neurological disease during an outbreak in children in Colorado, USA, in 2018: An observational cohort study. Lancet Infect Dis 2020;20(2):230–9. DOI: 10.1016/S1473-3099(19)30632-2

37. Kirolos A., Mark K., Shetty J. et al. NHS Lothian EV-D68 Associated AFM Study Group. Outcome of paediatric acute flaccid myelitis associated with enterovirus D68: A case series. Dev Med Child Neurol 2019;61(3):376–80. DOI: 10.1111/dmcn.14096

38. Bove R., Rowles W., Carleton M. et al. Unmet needs in the evaluation, treatment, and recovery for 167 children affected by acute flaccid myelitis reported by parents through social media. Pediatr Neurol 2020;102:20–7. DOI: 10.1016/j.pediatrneurol.2019.08.009

39. Emamhadi M., Andalib S. Double nerve transfer for restoration of hand grasp and release in C7 tetraplegia following complete cervical spinal cord injury. Acta Neurochir (Wien) 2018;160(11):2219–24. DOI: 10.1007/s00701-018-3671-0

40. Werner J.M., Berggren J., Kim G. et al. Recommendations for therapy following nerve transfer for children with acute flaccid myelitis. Phys Occup Ther Pediatr. 2021;41(2):209–26. DOI:10.1080/01942638.2020.1822981.

41. Malessy M.J., Bakker D., Dekker A.J. et al. Functional magnetic resonance imaging and control over the biceps muscle after intercostal-musculocutaneous nerve transfer. J Neurosurg 2003;98(2):261–8. DOI: 10.3171/jns.2003.98.2.0261

42. Murphy O.C., Messacar K., Benson L. et al. AFM working group. Acute flaccid myelitis: cause, diagnosis, and management. Lancet 2021;23;397(10271):334–46. DOI: 10.1016/S0140-6736(20)32723-9

43. Leechavengvongs S., Witoonchart K., Uerpairojkit C., Thuvasethakul P. Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: A report of 7 cases. J Hand Surg Am 2003;28(4):633–8. DOI: 10.1016/s0363-5023(03)00199-0

44. Teboul F., Kakkar R., Ameur N. et al. Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy. J Bone Joint Surg Am 2004;86(7): 1485–90. DOI: 10.2106/00004623-200407000-00018

45. Merrell G.A., Barrie K.A., Katz D.L., Wolfe S.W. Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature. J Hand Surg Am 2001;26(2):303–14. DOI: 10.1053/jhsu.2001.21518