Rühmann O, Schmolke S, Bohnsack M, Carls J, Wirth C J
Hannover Medical School, Germany.
J Bone Joint Surg Br. 2005 Feb;87(2):184-90. doi: 10.1302/0301-620x.87b2.14906.
Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha's technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique. The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6 degrees (0 to 45) to 34 degrees (5 to 90) at the last review. The mean forward flexion increased from 12 degrees (0 to 85) to 30 degrees (5 to 90). Abduction (41 degrees) and especially forward flexion (43 degrees) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42 degrees of abduction and 56 degrees of forward flexion. Active abduction (28 degrees) and forward flexion (19 degrees) were much less in completely flail shoulders (n = 34). Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished. The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.
1994年3月至2003年6月期间，80例臂丛神经麻痹患者接受了斜方肌转移术。其中女性11例，男性69例，平均年龄31岁（18至69岁）。术前对患侧手臂的肌肉功能进行了全面评估。37例患者（46%）出现完全连枷臂。43例（54%）患者肘部和手部有一些周围功能。没有患者同时具备肘部的完全主动活动和手部的足够功能。患者平均随访2.4年（0.8至8年）。我们按照萨哈的技术进行手术，在最后22例手术中有改进。我们根据肌肉的术前状态和手术技术展示了结果的差异。转移术使所有患者的功能均有提高，74例（95%）患者肩部的多向不稳定有所减轻。在最后一次复查时，主动外展的平均增加幅度从6度（0至45度）提高到34度（5至90度）。前屈平均从12度（0至85度）增加到30度（5至90度）。当胸大肌仍有一些残余功能时（n = 32），外展（41度）尤其是前屈（43度）的改善更为明显。二头肌、喙肱肌和肱三头肌术前力量最强的患者（n = 7）取得了最佳效果，平均外展42度，前屈56度。完全连枷肩患者（n = 34）的主动外展（28度）和前屈（19度）则要少得多。对采用萨哈技术的19例患者和采用改良手术的15例患者（均为完全瘫痪）进行比较，结果显示后一种手术在改善肩部稳定性方面更优。在所有病例中，不稳定均有所减轻，下方半脱位消失。斜方肌转移术后的结果取决于术前的瘫痪模式和手术技术。与完全瘫痪的患者相比，二头肌、喙肱肌、胸大肌和肱三头肌有一定功能的患者能取得更好的效果。手术方法的简单改进可确保关节不稳定减轻，功能增强。
