Kostas-Agnantis Ioannis, Korompilias Anastasios, Vekris Marios, Lykissas Marios, Gkiatas Ioannis, Mitsionis Gregory, Beris Alexander
Orthopaedic Department, University Hospital of Ioannina, Greece.
Orthopaedic Department, University Hospital of Ioannina, Greece.
Injury. 2013 Mar;44(3):299-304. doi: 10.1016/j.injury.2013.01.005. Epub 2013 Jan 18.
In upper brachial plexus palsy patients, loss of shoulder function and elbow flexion is obvious as the result of paralysed muscles innervated by the suprascapular, axillary and musculocutaneus nerve. Shoulder stabilisation, restoration of abduction and external rotation are important as more distal functions will be affected by the shoulder situation.
Between 2005 and 2011, eleven patients with upper type brachial plexus palsy were operated on with triceps nerve branch transfer to anterior axillary nerve branch and spinal accessory nerve transfer to the suprascapular nerve for shoulder abduction and external rotation restoration. Nine patients met the inclusion criteria for the study. All patients were men with ages ranged from 21 to 35 years (average, 27.4 years). The interval between injury and surgery ranged from 4 to 11 months (average, 7.2 months). Atrophy of the supraspinatus, infraspinatus and deltoid muscle and subluxation at the glenohumeral joint was obvious in all patients preoperatively. During the pre-op examination all patients had at least muscle grading 4 on the triceps muscle.
The mean post-operative value of shoulder abduction was 112.2° (range: 60-170°) while preoperatively none of the patients was able for abduction (p<0.001). The mean post-operative value of shoulder external rotation was 66° (range: 35-110°) while preoperatively none of them was able for external rotation (p<0.001). Postoperative values of shoulder abduction were significantly better that those of external rotation (p=0.0004). The postoperative average muscle grading for shoulder abduction according the MRC scale was 3.6±0.5 and for the shoulder external rotation was 3.2±0.4.
Combined nerve transfer by using the spinal accessory nerve for suprascapular nerve neurotisation and one of the triceps nerve branches for axillary nerve and teres minor branch neurotisation is an excellent choice for shoulder abduction and external rotation restoration.
在上臂丛神经麻痹患者中，由于肩胛上神经、腋神经和肌皮神经支配的肌肉麻痹，肩部功能丧失和肘关节屈曲明显。肩部稳定、外展和外旋的恢复很重要，因为更远端的功能会受到肩部状况的影响。
2005年至2011年期间，对11例上臂型臂丛神经麻痹患者进行了手术，将肱三头肌神经分支转移至腋前神经分支，并将副神经转移至肩胛上神经，以恢复肩部外展和外旋功能。9例患者符合研究纳入标准。所有患者均为男性，年龄在21至35岁之间（平均27.4岁）。受伤至手术的间隔时间为4至11个月（平均7.2个月）。术前所有患者的冈上肌、冈下肌和三角肌均有萎缩，肩关节半脱位明显。术前检查时，所有患者的肱三头肌肌力至少为4级。
术后肩部外展的平均值为112.2°（范围：60 - 170°），而术前所有患者均无法外展（p<0.001）。术后肩部外旋的平均值为66°（范围：35 - 110°），术前所有患者均无法外旋（p<0.001）。术后肩部外展值明显优于外旋值（p = 0.0004）。根据MRC量表，术后肩部外展的平均肌力分级为3.6±0.5，肩部外旋为3.2±0.4。
使用副神经进行肩胛上神经神经化，并用肱三头肌神经分支之一进行腋神经和小圆肌分支神经化的联合神经转移术，是恢复肩部外展和外旋功能的极佳选择。
