Gutierrez-Pereira Javier, Garcia-Lopez Antonio
Spanish National Reference Center for Brachial Plexus Surgery, Hospital General Universitario de Alicante: Hospital General Universitario Dr Balmis, Alicante, Spain.
J Brachial Plex Peripher Nerve Inj. 2025 Jun 19;20(1):e41-e46. doi: 10.1055/a-2618-3151. eCollection 2025 Jan.
The latissimus dorsi tendon transfer (LDTT) to the supraspinatus tendon is a common procedure for restoring shoulder abduction and external rotation in upper root brachial plexus lesions. However, its association with scapular retraction often limits shoulder abduction.
This retrospective study compared the functional outcomes of teres major tendon transfer (TMTT) combined with anterior coracohumeral ligament release (CHLR) versus LDTT. Patients who underwent surgery at our center between January 2012 and December 2022 were included, with a mean follow-up of 38 months. Outcomes were assessed using a range of motion and the Mallet scale.
A total of 40 patients were included, with 20 undergoing TMTT with CHLR and 20 undergoing LDTT. The overall mean age was 3.9 years (range: 2.7-4.8), with mean ages of 3.4 years (range: 2.2-5.2) in the LDTT group and 4.1 years (range: 2.8-5.2) in the TMTT with the CHLR group. The TMTT with CHLR group achieved mean gains of +77 degrees in active abduction, +44 degrees in active external rotation, and +46 degrees in passive external rotation. In comparison, the LDTT group demonstrated gains of +46, +27, and +24 degrees, respectively, for the same parameters.
TMTT combined with anterior CHLR significantly improves shoulder abduction and external rotation in patients with Brachial plexus birth injury, particularly those with internal rotation contractures. This technique offers superior functional outcomes compared to LDTT, suggesting a more effective therapeutic alternative.
IV, retrospective comparative study.
背阔肌腱转移至冈上肌腱是恢复上根型臂丛神经损伤患者肩关节外展和外旋功能的常用手术方法。然而，该手术常伴有肩胛骨回缩，这往往会限制肩关节外展。
本回顾性研究比较了大圆肌腱转移术（TMTT）联合喙肱前韧带松解术（CHLR）与背阔肌腱转移术（LDTT）的功能结局。纳入2012年1月至2022年12月在本中心接受手术的患者，平均随访38个月。采用活动度和马利特量表评估结局。
共纳入40例患者，其中20例行TMTT联合CHLR，20例行LDTT。总体平均年龄为3.9岁（范围：2.7 - 4.8岁），LDTT组平均年龄为3.4岁（范围：2.2 - 5.2岁），TMTT联合CHLR组平均年龄为4.1岁（范围：2.8 - 5.2岁）。TMTT联合CHLR组主动外展平均增加77°，主动外旋平均增加44°，被动外旋平均增加46°。相比之下，LDTT组相同参数的增加分别为46°、27°和24°。
TMTT联合喙肱前韧带松解术可显著改善臂丛神经产伤患者的肩关节外展和外旋功能，尤其是伴有内旋挛缩的患者。与LDTT相比，该技术具有更好的功能结局，提示其为一种更有效的治疗选择。
IV级，回顾性比较研究。
