Institute of Nerve and Brachial Plexus Surgery, 92 Boulevard de Courcelles, 75017 Paris, France.
Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, Boulevard Fleming, 25030 Besançon, France.
Injury. 2020 Dec;51 Suppl 4:S84-S87. doi: 10.1016/j.injury.2020.02.005. Epub 2020 Feb 10.
Restoration of shoulder external rotation in partial brachial plexus palsies is a real challenge. The transfer of the spinal accessory nerve to the suprascapular nerve remains the gold standard. This transfer, however, cannot be always performed. Therefore, in these cases, we previously proposed the transfer of the rhomboid nerve to the suprascapular nerve through a posterior approach. The goal of the present study is to assess this technique through a short series. Eight male patients had a partial plexus palsy. Five patients had C5, C6 root injuries, two patients had C5, C6, C7 root injuries, and one patient had C5 to C8 root injuries. No patients had C5 or C6 root avulsions. In one patient, the spinal accessory nerve was injured and in seven patients, the proximal suprascapular nerve was not available. All patients underwent a transfer from the rhomboid nerve to the suprascapular nerve. Concerning shoulder elevation, transfers from the branch of the long head of the triceps or ulnar nerve fascicle were transferred to the axillary nerve. For elbow flexion, fascicles from the ulnar nerve, median nerve, or both were used. For elbow extension, three intercostal nerves in one patient and one fascicle from the ulnar nerve in two patients were transferred to the branch of the long head of the triceps. For wrist and finger extension, palliative surgery was proposed. All patients recovered external shoulder rotation (from 70-110º) and shoulder elevation (range, 80-140º). Active elbow flexion was coded M4 in seven patients and M3 in one patient. All patients recovered active elbow extension. The transfer of the rhomboid nerve to the suprascapular nerve is an efficient procedure for shoulder external rotation in partial brachial plexus palsies without C5 root avulsion. The results in terms of range-of-motion are, however, poorer than with the spinal accessory nerve. Therefore, this technique is appropriate if the spinal accessory nerve is injured or if the suprascapular nerve is not available in the cervical area. This technique must be associated with another transfer to the axillary nerve for shoulder elevation. The study of more patients will be necessary to confirm these results.
在部分臂丛神经麻痹中，恢复肩部外旋是一个真正的挑战。副神经向肩胛上神经的转移仍然是金标准。然而，这种转移并非总是可行的。因此，在这些情况下，我们之前提出通过后路将菱形肌神经转移到肩胛上神经。本研究的目的是通过一个小系列来评估这种技术。8 名男性患者患有部分臂丛神经麻痹。5 名患者 C5、C6 神经根损伤，2 名患者 C5、C6、C7 神经根损伤，1 名患者 C5 至 C8 神经根损伤。无患者 C5 或 C6 神经根撕脱。1 名患者副神经受伤，7 名患者近端肩胛上神经不可用。所有患者均接受从菱形肌神经到肩胛上神经的转移。关于肩部抬高，将肱三头肌长头的分支或尺神经束转移到腋神经。对于肘部弯曲，使用尺神经、正中神经或两者的束。对于肘部伸展，1 名患者的 3 根肋间神经和 2 名患者的 1 根尺神经束转移到肱三头肌长头的分支。对于手腕和手指伸展，提出姑息性手术。所有患者均恢复了肩部外旋（70-110°）和肩部抬高（80-140°）。7 名患者肘部弯曲肌力为 M4，1 名患者为 M3。所有患者均恢复了主动肘部伸展。在没有 C5 神经根撕脱的情况下，将菱形肌神经转移到肩胛上神经是治疗部分臂丛神经麻痹外旋的有效方法。然而，在运动范围方面的结果不如副神经好。因此，如果副神经受伤或在颈部区域找不到肩胛上神经，这种技术是合适的。这种技术必须与另一种转移到腋神经以进行肩部抬高相结合。需要更多的患者研究来证实这些结果。
