Orthopedic and Trauma Surgery, New Valley University, ELkharga City, Egypt.
Head of the microsurgery Unit, Assiut University, Assiut City, Egypt.
BMC Musculoskelet Disord. 2024 Nov 18;25(1):924. doi: 10.1186/s12891-024-08048-y.
Deficient shoulder function is a common and exhausting issue in children with obstetric brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is markedly disabled by limited shoulder abduction external rotation. Lower trapezius transfer carries many advantages; simple and safe technique, same line of pull as donor; reliable nerve supply (extraplexal from spinal accessory nerve), and not acting on rotation of the shoulder, mostly it will not adversely affect internal rotation range after the transfer. This study aims to evaluate the role of isolated lower trapezius transfer in reconstructing shoulder external rotation.
This prospective case series study included 20 patients with sequelae of obstetric brachial plexus injury lacking shoulder external rotation who underwent lower trapezius transfer to infraspinatus. In all cases, the lower trapezius muscle was the donor, and the recipient tendon was the Infraspinatus muscle. Shoulder range of motion, Modified Gilbert grading, and Mallet Classification were used to evaluate results.
The mean age at the time of surgery was 4.5 years. The average increase in shoulder external rotation and abduction was 40⁰ and 42.5⁰ respectively, the modified Gilbert grading improved from a mean of 3.85 to 4.85 postoperative. Mallet classification improved from a mean of 3.5 preoperative to 4.8 postoperative. Improvement (Mallet classification of ≥ 4) was obtained in 18 cases (90%).
Isolated lower trapezius transfer is considered an effective option with promising results in cases of sequelae of obstetric brachial plexus injury for restoration of shoulder external rotation as well as abduction.
肩部功能障碍是产伤性臂丛神经损伤患儿常见且令人疲惫的问题。即使肘部、腕部和手指功能正常，由于肩部外展和外旋受限，上肢功能仍明显受限。斜方肌下部转移具有许多优点：技术简单、安全，与供体在同一直线上；神经供应可靠（来自副神经的椎管外分支），且不作用于肩部旋转，转移后大多不会对内部旋转范围产生不利影响。本研究旨在评估孤立性斜方肌下部转移在重建肩部外旋中的作用。
本前瞻性病例系列研究纳入了 20 例因产伤性臂丛神经损伤导致肩部外旋缺失的后遗症患者，他们接受了斜方肌下部转移至肩胛冈下肌的手术。在所有病例中，斜方肌下部是供体，肩胛冈下肌是受体肌腱。使用肩关节活动范围、改良吉尔伯特分级和马勒分类来评估结果。
手术时的平均年龄为 4.5 岁。肩部外旋和外展的平均增加分别为 40°和 42.5°，改良吉尔伯特分级从术后的平均 3.85 分提高到 4.85 分。马勒分类从术前的平均 3.5 分提高到术后的 4.8 分。18 例（90%）获得改善（马勒分类≥4）。
孤立性斜方肌下部转移被认为是一种有效的选择，对于恢复肩部外旋和外展，在产伤性臂丛神经损伤后遗症中具有良好的效果。
