Rayidi Venkata Koteswara Rao, R Srikanth, Appaka Jagadish Kiran C V
Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.
Indian J Plast Surg. 2021 Jan;54(1):38-45. doi: 10.1055/s-0040-1721865. Epub 2021 Feb 8.
Brachial plexus injuries are severe life-altering injuries. The surgical method to restore shoulder abduction in adult upper brachial plexus injuries involves the usage of nerve grafts and nerve transfers targeting the suprascapular and/or the axillary nerve. When the primary nerve surgery has been unsuccessful or recovery has been incomplete or with a late presentation, muscle transfer procedures are needed to provide or improve shoulder abduction. Levator scapulae to supraspinatus is a transfer to improve shoulder abduction in posttraumatic brachial plexus injuries. The study included 13 patients with the age ranging from 17 to 47 years with a mean age of 30 years. All these patients had preop shoulder abduction of Medical Research Council (MRC) grade ≤3. All had a minimum of MRC grade 4 of active elbow flexion. Eleven patients had primary surgery. Only patients with a minimum of 1 year postoperative follow-up were included. All 13 patients underwent levator scapulae transfer only. All patients had a stable shoulder postoperatively. The average increase in active shoulder abduction was from 6.15°(median: 0°) preoperatively to 61.92°(median: 60°), with an average gain in shoulder abduction of 49.61°(median: 50°). Transfer of levator scapulae tendon to the supraspinatus is an option to improve shoulder abduction in posttraumatic brachial plexus. In conditions where supraspinatus alone is not functioning, levator scapulae is the best available transfer, considering its strength and maintaining the form of the shoulder unlike trapezius transfer. In patients with previous surgery where supraspinatus has recovered partially but not functionally significant, this tendon transfer can be considered for the augmentation of the existing shoulder abduction.
臂丛神经损伤是严重改变生活的损伤。在成人上干臂丛神经损伤中，恢复肩关节外展的手术方法包括使用神经移植和针对肩胛上神经和/或腋神经的神经移位。当初次神经手术不成功或恢复不完全或就诊较晚时，需要进行肌肉移位手术以提供或改善肩关节外展。肩胛提肌移位至冈上肌是一种用于改善创伤后臂丛神经损伤患者肩关节外展的移位手术。
该研究纳入了13例年龄在17至47岁之间的患者，平均年龄为30岁。所有这些患者术前肩关节外展的医学研究委员会（MRC）分级均≤3级。所有患者的主动肘关节屈曲至少达到MRC 4级。11例患者接受了初次手术。仅纳入术后至少随访1年的患者。所有13例患者均仅接受了肩胛提肌移位手术。
所有患者术后肩关节均稳定。主动肩关节外展的平均增加量从术前的6.15°（中位数：0°）增加到61.92°（中位数：60°），肩关节外展平均增加了49.61°（中位数：50°）。
将肩胛提肌腱移位至冈上肌是改善创伤后臂丛神经损伤患者肩关节外展的一种选择。在冈上肌单独无法发挥功能的情况下，考虑到肩胛提肌的力量以及与斜方肌移位不同，它能保持肩部形态，肩胛提肌是最佳的可用移位肌肉。对于之前接受过手术且冈上肌已部分恢复但功能仍不显著的患者，可考虑进行这种肌腱移位手术以增强现有的肩关节外展功能。
