Bigliani L U, Compito C A, Duralde X A, Wolfe I N
Shoulder Service, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, New York City 10032, USA.
J Bone Joint Surg Am. 1996 Oct;78(10):1534-40. doi: 10.2106/00004623-199610000-00011.
Twenty-two patients who had paralysis of the trapezius muscle secondary to injury of the spinal accessory nerve had transfer of the levator scapulae and rhomboid major and minor muscles. In each patient, function of the trapezius had failed to improve with either physical therapy or an operative attempt at neurolysis or reconstruction of the spinal accessory nerve. The etiology of the injury was biopsy of a cervical node in thirteen patients, trauma in seven, and radical dissection in the neck in two. All patients had pain, visible deformity, and dysfunction of the shoulder girdle. Physical examination revealed asymmetry of the neckline, drooping of the shoulder girdle with lateral displacement of the scapula, and weakness of active elevation. Fourteen patients had had an incorrect clinical diagnosis, and twelve patients had had an inaccurate or incomplete electromyographic examination. A long thoracic nerve palsy developed in three patients. At an average of seven and a half years (range, two to fourteen years), the result of the operative procedure, as determined with the American Shoulder and Elbow Surgeons Shoulder Evaluation Form, was excellent for thirteen patients, satisfactory for six, and unsatisfactory for three. All but three patients had adequate relief of pain and demonstrable functional improvement.
22例因副神经损伤继发斜方肌麻痹的患者接受了肩胛提肌及大小菱形肌转移术。在每例患者中，无论是物理治疗，还是对副神经进行神经松解或重建的手术尝试，斜方肌的功能均未得到改善。损伤的病因在13例患者中是颈部淋巴结活检，7例是外伤，2例是颈部根治性清扫术。所有患者均有疼痛、明显畸形及肩胛带功能障碍。体格检查发现领口不对称、肩胛带下垂伴肩胛骨向外侧移位，以及主动上举无力。14例患者临床诊断有误，12例患者肌电图检查不准确或不完整。3例患者出现了胸长神经麻痹。平均随访7.5年（范围2至14年），根据美国肩肘外科医师协会肩部评估表评估，手术结果13例患者为优，6例为良，3例为差。除3例患者外，所有患者疼痛均得到充分缓解，功能有明显改善。
