Gracitelli Mauro Emilio Conforto, Assunção Jorge Henrique, Malavolta Eduardo Angeli, Sakane Daniel Takashi, de Rezende Marcelo Rosa, Ferreira Neto Arnaldo Amado
Universidade de São Paulo, Faculdade de Medicina, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
Acta Ortop Bras. 2014;22(6):304-7. doi: 10.1590/1413-78522014220600931.
To compare the viability of transferring the lower and transverse trapezius to the greater tuberosity using three different techniques.
Twelve shoulders from six cadavers were used. The primary outcome was to assess the suture viability of the trapezius muscle transfer to the greater tuberosity in the insertion topography of the infraspinatus, with the arm adducted during internal rotation (hand on the abdomen) and maximum scapular retraction. Three transfers were applied to each shoulder: the lower and transverse trapezius distal insertion (Group 1); lower trapezius alone (Group 2); and lower trapezius insertion and origin (Group 3). Accessory nerve integrity was assessed before and after transfers.
Sutures were viable in 42% (5/12) and 58% (7/12) on Groups 1 and 3, respectively, with no statistically significant difference (Fisher's test, p=0.558); Group 3 exhibited frequent neurologic injury (11/12). Group 2 was the least successful; the tendon did not reach the greater tuberosity, and no sutures were viable.
Groups 1 and 3 exhibited the best nongrafting suture viability to the greater tuberosity; however, Group 3 was associated to frequent spinal accessory nerve injury. Level of Evidence IV, Anatomical Study.
比较使用三种不同技术将下斜方肌和横斜方肌转移至大结节的可行性。
使用来自六具尸体的12个肩部。主要结果是评估在冈下肌插入部位，当手臂内收（手放在腹部）且肩胛骨最大限度后缩时，斜方肌转移至大结节的缝合可行性。每个肩部应用三种转移方式：下斜方肌和横斜方肌远端插入（第1组）；单独下斜方肌（第2组）；下斜方肌插入和起点（第3组）。在转移前后评估副神经的完整性。
第1组和第3组的缝合分别有42%（5/12）和58%（7/12）可行，无统计学显著差异（Fisher检验，p = 0.558）；第3组出现频繁的神经损伤（11/12）。第2组最不成功；肌腱未到达大结节，且无缝合可行。
第1组和第3组对大结节的非移植缝合可行性最佳；然而，第3组与频繁的副神经损伤相关。证据等级IV，解剖学研究。
