Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Hand and Upper Extremity Surgery, Limb Function Reconstruction Center, Jing'an District Central Hospital, Shanghai, China.
Acta Neurochir (Wien). 2023 May;165(5):1179-1188. doi: 10.1007/s00701-023-05553-2. Epub 2023 Mar 21.
Hyperselective neurectomy is a reliable treatment for spasticity. This research was designed to quantify the surgical parameters of hyperselective neurectomy of thoracodorsal nerve for shoulder spasticity through anatomical studies, as well as to retrospectively assess patients who underwent this procedure to provide an objective basis for clinical practice.
On nine embalmed adult cadavers (18 shoulders), we dissected and observed the branching patterns of thoracodorsal nerve, counted the number of nerve branches, measured the distribution of branch origin point, and determined the length of the surgical incision. Next, we selected five patients who underwent this procedure for shoulder spasticity and retrospectively evaluated (ethic committee: 2022-37) their shoulder function with active/passive range of motion (AROM/PROM) and modified Ashworth scale (MAS).
The anatomical study revealed that the main trunk of thoracodorsal nerve sends out one to three medial branches, with the pattern of only one medial branch being the most common (61.1%); there were significant variations in the branch numbers and nerve distributions; the location of thoracodorsal nerve branches' entry points into the muscle varied from 27.2 to 67.8% of the length of the arm. Clinical follow-up data showed significant improvement in shoulder mobility in all patients. AROM of shoulder abduction increased by 39.4° and PROM increased by 64.2° (P < 0.05). AROM and PROM of shoulder flexion increased by 36.6° and 54.4°, respectively (P < 0.05). In addition, the MAS of shoulder abduction (1.8) and flexion (1.2) was both significantly reduced in all patients (P < 0.05).
Hyperselective neurectomy of thoracodorsal nerve is effective and stable in the treatment of shoulder spasticity. Intraoperative attention is required to the numbers of the medial branch of thoracodorsal nerve. We recommend an incision in the mid-axillary line that extends from 25 to 70% of the arm length to fully expose each branch.
神经高选择性切断术是治疗痉挛的可靠方法。本研究旨在通过解剖学研究量化胸背神经高选择性神经切断术治疗肩部痉挛的手术参数，并对接受该手术的患者进行回顾性评估，为临床实践提供客观依据。
在 9 具防腐成人尸体（18 个肩部）上，我们对胸背神经的分支模式进行解剖和观察，计数神经分支数量，测量分支起源点的分布，并确定手术切口的长度。然后，我们选择了 5 名接受该手术治疗肩部痉挛的患者，并对他们的肩部功能进行回顾性评估（伦理委员会：2022-37），包括主动/被动活动范围（AROM/PROM）和改良 Ashworth 量表（MAS）。
解剖学研究表明，胸背神经的主干发出 1 至 3 个内侧支，其中只有一个内侧支的模式最为常见（61.1%）；分支数量和神经分布存在显著差异；胸背神经分支进入肌肉的位置在臂长的 27.2%至 67.8%之间变化。临床随访数据显示，所有患者的肩部活动度均有显著改善。肩部外展的 AROM 增加了 39.4°，PROM 增加了 64.2°（P<0.05）。肩部前屈的 AROM 和 PROM 分别增加了 36.6°和 54.4°（P<0.05）。此外，所有患者的肩部外展（1.8）和前屈（1.2）的 MAS 均显著降低（P<0.05）。
胸背神经高选择性神经切断术治疗肩部痉挛有效且稳定。术中应注意胸背神经内侧支的数量。我们建议在腋中线做一个切口，从臂长的 25%到 70%处延伸，以充分暴露每个分支。
