Cambon-Binder Adeline, Preure Lynda, Dubert-Khalifa Heba, Marcheix Pierre-Sylvain, Belkheyar Zoubir
1 Orthopedic and Hand Surgery Department, Saint-Antoine Hospital, Paris, Sorbonne Université, France.
2 Groupement hospitalier Eaubonne Montmorency, Hôpital Simone Veil, Eaubonne, France.
J Hand Surg Eur Vol. 2018 Jul;43(6):589-595. doi: 10.1177/1753193418755618. Epub 2018 Feb 12.
Spinal accessory nerve grafting requires identification of both nerve stumps in the scar tissue, which is sometimes difficult. We propose a direct nerve transfer using a fascicle from the posterior division of the upper trunk. We retrospectively reviewed 11 patients with trapezius palsy due to an iatrogenic injury of the spinal accessory nerve in nine cases. The mean age was 38 years (range 21-59). Preoperatively, patients showed shoulder weakness and limited range of motion. At a mean follow-up of 25 months, active shoulder abduction improvement averaged 57°. Trapezius muscle strength graded M4 or M5 in 10 cases and M3 in one case. No deltoid or triceps impairment was reported. Scapula kinematics was considered normal in seven patients. This technique gave satisfactory functional results and may be an alternative to spinal accessory nerve grafting for the management of trapezius palsies if direct repair is not feasible.
IV.
副神经移植需要在瘢痕组织中识别出两个神经残端，这有时很困难。我们提出使用来自臂丛上干后股的一束神经进行直接神经移位。我们回顾性分析了11例因副神经医源性损伤导致斜方肌麻痹的患者，其中9例。平均年龄为38岁（范围21 - 59岁）。术前，患者表现为肩部无力和活动范围受限。平均随访25个月时，主动肩外展改善平均为57°。10例患者斜方肌肌力分级为M4或M5，1例为M3。未报告三角肌或肱三头肌功能受损。7例患者的肩胛骨运动学被认为正常。该技术取得了满意的功能结果，如果直接修复不可行，对于治疗斜方肌麻痹可能是副神经移植的一种替代方法。
IV。
