Institut de la Main, Paris Shoulder Unit, Clinique Bizet, 23, Rue Georges Bizet, 75116 Paris, France.
Hand Surg Rehabil. 2022 Feb;41S:S39-S43. doi: 10.1016/j.hansur.2020.11.014. Epub 2021 Aug 15.
The lack of active external rotation following a brachial plexus injury in adults is very disabling and very challenging to solve. If direct nerve surgery or nerve transfer fails or if the patient is seen too late, palliative surgery is the last resort. Shoulder fusion can stabilize the joint to increase strength at the elbow, but the patient loses all external rotation. A metaphyseal humeral osteotomy shifts the sector of mobility to push out the arm from the chest but does not restore any active external rotation. Latissimus dorsi and teres major transfers are not indicated in traumatic brachial plexus injuries. Lower trapezius (inferior fibers of the trapezius) transfer detached from the medial angle of the scapula and fixed to the infraspinatus tendon is the main option in paralyzed shoulders. It can restore 90° external rotation on average. This tendon transfer is an agonist, with the same direction but with less excursion and strength. If this muscle is paralyzed (nerve lesion), one can harvest and transfer the contralateral lower trapezius instead. The goals of this paper are to describe the surgical technique for these two tendons transfer, their indications and results.
成人臂丛神经损伤后缺乏主动外旋功能非常不便，且难以解决。如果直接神经手术或神经转移失败，或者患者就诊太晚，姑息性手术是最后的手段。肩关节融合术可以稳定关节，增加肘部力量，但患者会完全失去外旋功能。肱骨干骺端截骨术可以将活动范围转移，将手臂从胸部推出，但不能恢复任何主动外旋功能。Latissimus dorsi 和 teres major 转移不适用于创伤性臂丛神经损伤。从肩胛骨内侧角游离并固定到肩胛下肌腱的下斜方肌（斜方肌的下部纤维）转移是瘫痪肩部的主要选择。它可以平均恢复 90°的外旋。这种肌腱转移是一种协同肌，方向相同，但活动度和力量较小。如果这块肌肉瘫痪（神经损伤），可以选择同侧或对侧下斜方肌来进行移植。本文的目的是描述这两种肌腱转移的手术技术、适应证和结果。
