Matory W E, Morgan W J, Breen T
Division of Plastic and Reconstructive Surgery, University of Massachusetts Medical Center, Worcester 01655.
J Hand Surg Am. 1991 Jan;16(1):12-8. doi: 10.1016/s0363-5023(10)80004-8.
Modification of pectoralis major transfer as originally described by Clark in 1946 have not addressed concerns such as diminished strength and excursion of the transfer, along with obligatory supination of the forearm. Postoperative scarring from the long oblique chest incision further compounds the psychological impairment that accompanies brachial plexopathy. One hundred forty-three brachial plexopathies were seen over a five-year period. Seven pectoralis major transfers were done to restore elbow flexion in patients with C5-6 and C5-6-7 cord injuries. Mean age and follow-up were 26 years and 25 months respectively. The modifications of this transfer we use improve strength and range of motion by preserving dual innervation of the muscle, by tubularization of the transfer, and by restoration of the transverse aponeurosis as a fascial pulley. By transfer of the pectoralis insertion to the acromion, further anterior shoulder stability may be obtained. Aesthetics can also be improved by use of selected midline and deltopectoral incisions, along with preservation of the remaining pectoralis major and minor.
1946年克拉克最初描述的胸大肌转移术的改良方法，并未解决诸如转移肌力量减弱和活动范围受限，以及前臂必然旋前等问题。长斜行胸部切口导致的术后瘢痕，进一步加重了臂丛神经病变所伴随的心理障碍。在五年期间共诊治了143例臂丛神经病变患者。对7例C5-6和C5-6-7脊髓损伤患者进行了胸大肌转移术以恢复肘关节屈曲功能。平均年龄和随访时间分别为26岁和25个月。我们采用的这种转移术改良方法，通过保留肌肉的双重神经支配、转移肌的管状化以及将横向腱膜恢复为筋膜滑轮，来提高力量和活动范围。通过将胸大肌止点转移至肩峰，可进一步获得肩关节前方稳定性。通过选用中线和三角肌胸大肌切口，以及保留胸大肌和胸小肌的其余部分，还可改善美观效果。
