From the Sorbonne University, Department of Orthopaedic and Trauma Surgery, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital; and Clinique du Mont Louis.
Plast Reconstr Surg. 2022 Mar 1;149(3):672-675. doi: 10.1097/PRS.0000000000008851.
In patients with C5-C6 brachial plexus injury, spinal accessory nerve transfer to the suprascapular nerve is usually performed for the restoration of shoulder abduction. In order to minimize donor deficits, we transferred one fascicle of the ipsilateral C7 root, dedicated to the pectoralis major muscle, to the suprascapular nerve.
Ten patients with a mean age of 33 years (range, 19 to 51 years) were operated on at a mean delay of 4 months after their trauma (range, 2 to 7 months). Patients had C5-C6 brachial plexus palsy with avulsed roots on spinal magnetic resonance imaging scan. In addition to the partial C7 transfer, patients sustained nerve transfers to the posterior branch of the axillary nerve and to the motor branches of the musculocutaneous nerve for the biceps and brachialis muscles.
At a mean follow-up of 36 months (range, 29 to 42 months), mean shoulder abduction and external rotation ranges of motion were, respectively, 99 degrees (range, 60 to 120 degrees; p = 0.001) and 58 degrees (range, 0 to 80 degrees; p = 0.001). In nine patients, shoulder abduction strength was graded M4, according the British Medical Research Council grading scale, against 1.6 kg (range, 1 to 2 kg), and was graded M3 in one patient. External rotation strength was graded M4 in nine patients and M3 in one patient. Residual strength of the pectoralis major muscle was graded M4+ in every patient.
C7 partial transfer to the suprascapular nerve showed satisfactory results at long-term follow-up for active shoulder abduction and external rotation recovery in C5-C6 brachial plexus palsies. This technique replaced spinal accessory nerve transfer in the authors' practice.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在 C5-C6 臂丛神经损伤的患者中，通常会进行副神经转移到肩胛上神经以恢复肩部外展。为了最大限度地减少供体缺陷，我们将同侧 C7 神经根的一个束支，专门用于胸大肌的，转移到肩胛上神经。
10 名患者的平均年龄为 33 岁（范围为 19 至 51 岁），在创伤后平均 4 个月（范围为 2 至 7 个月）进行手术。患者在脊髓磁共振成像扫描中显示 C5-C6 臂丛神经根撕脱。除了部分 C7 转移外，患者还进行了神经转移到腋神经后支和肌皮神经的运动支，用于肱二头肌和肱肌。
平均随访 36 个月（范围为 29 至 42 个月），平均肩外展和外旋活动范围分别为 99 度（范围为 60 至 120 度；p = 0.001）和 58 度（范围为 0 至 80 度；p = 0.001）。在 9 名患者中，肩外展力量根据英国医学研究理事会分级量表评为 M4 级，对抗 1.6 公斤（范围为 1 至 2 公斤），1 名患者评为 M3 级。外旋力量在 9 名患者中评为 M4 级，1 名患者评为 M3 级。每个患者的胸大肌残余力量均评为 M4+级。
在 C5-C6 臂丛神经损伤患者中，C7 部分转移到肩胛上神经在长期随访中显示出令人满意的结果，可主动恢复肩外展和外旋。该技术在作者的实践中取代了副神经转移。
临床问题/证据水平：治疗，IV。
