对改良斜方肌移位术治疗臂丛神经损伤后肩外展障碍的疗效观察

Modified trapezius transfer for sequelae of brachial plexus injury with shoulder abduction dysfunction

目的 探讨改良斜方肌移位术治疗臂丛神经损伤后肩关节外展功能障碍的疗效。方法 2016年1月至2020年12月间在北京积水潭医院手外科收治的晚期臂丛神经损伤患者17例采用改良的斜方肌移位术重建肩关节外展功能。基于Mayer手术加以改良,包括用异体肌腱紧缩肩关节囊,纠正肩关节脱位或半脱位,稳定肩关节;剥离斜方肌止点时只包括骨膜组织,而不做肩峰截骨,使用异体肌腱对斜方肌进行延长;将斜方肌止点重建于三角肌粗隆,在保证外展肌力臂的情况下,保留肩峰对肱骨头的阻挡作用,使移位的斜方肌作用力充分用于使肩关节外展,而不会将肱骨头拉向近端。比较手术前后肩关节主动外展情况和上肢功能评定表(DASH)评分。结果 17例患者使用改良的斜方肌移位术对肩关节外展功能进行重建。术前肩关节主动外展平均为20.6(10~30)°,术后平均为72.3(45~90)°。其中10例DASH评分从术前平均88.1(83~95)分降为平均40.5(28~58)分。结论 改良斜方肌移位术用于治疗臂丛神经上、中干损伤导致的晚期肩关节外展功能障碍有效,可明显改善上肢功能。

Objective To explore the efficacy of the treatment of shoulder sequelae in adult with brachial plexus injury by the modified trapezius transfer.Methods A retrospective study was conducted on 17 patients with sequelae of brachial plexus injury treated in Beijing Jishuitan Hospital from January 2016 to December 2020.The modified trapezius transfer was used to reconstruct shoulder abduction function.The method was similar to the Mayer's procedure,while some improvements were made.The shoulder joint capsule was tightened with allogeneic tendon to correct the dislocation or subluxation of the shoulder joint and to stabilize the shoulder joint.Trapezius tendon was lengthened using allogeneic tendon to avoid cutting off the lateral aspect of the acromion where was the trapezius insertion.Extended trapezius tendon could be easily transfered to deltoid tuberosity while the complete acromion could prevent the proximal displacement of the humeral head,that make the transfered trapezius fully abduct the shoulder instead of pulling the humeral head proximally.The disabilities of the arm,shoulder and hand(DASH)and the average active abduction of shoulder were recorded preoperatively and prstoperatively.Results The abduction function of shoulder was reconstructed by modified trapezius transfer in 17 patients.The average active abduction of shoulder was 20.6(10-30)°preoperatively and 72.3(45-90)°postoperatively.The average score of DASH in 10 cases decreased from 88.1(83-95)preoperatively to 40.5(28-58)postoperatively.Conclusion Modified trapezius transfer is effective in the treatment of sequelae of upper and middle trunk injury of adult brachial plexus with shoulder abduction dysfunction,and can significantly improve the function of upper limb.