通过锁骨段上斜方肌转位恢复臂丛神经损伤后

原文出处

AgrawalNK.Transferofuppertrapeziuswithclavicularsegmentforrestorationofshouldermovementsfollowinginjurytothebrachialplexus.PlastAesthetRes;2:-9.

DOI:10./-.

摘要

目的：大多数臂丛麻痹发生在高速创伤后。肩关节是影响手运动的大的近侧关节。斜方肌的转移是三角肌和冈上肌肌肉麻痹的有效替代。方法：年至年间，采用改良斜方肌转移疗法治疗32例患者，所有病例只使用了附着于锁骨外侧三分之一的下行纤维。锁骨用松质螺钉固定在肱骨前外侧表面。上肢制动6周。结果：32例患者均有功能改善，肩关节稳定。平均主动外展从7.5°（范围：0°-30°）增加至85°（范围：45°-°），平均前屈从5.63°（范围：0°-15°）在平均随访8.25个月后达到55.2°（范围：40°-90°）。32名患者中有24名评价结果为良好，对稳定性和功能的改善感到满意。95.38%的病人在手术后肌力为4级。结论：锁骨段上斜方肌转位治疗连枷肩可获得满意的功能和稳定性，并发症较少。

关键词：臂丛神经，肩关节融合术，斜方肌转位

Aim:Mostbrachialplexuspalsiesoccurfollowinghigh-velocitytrauma.Theshoulderjointisalargeproximaljointwhichinfluencesmotionofthehand.Transferofthetrapeziusmuscleisaneffectivealternativeforpalsyofthedeltoidandsupraspinatusmuscles.Methods:Betweenand,32patientsweretreatedwithmodifiedtrapeziusmuscletransferinwhichonlythedescendingfibresalongwiththeirattachmenttothelateralthirdofclaviclewereused.Theclaviclewasfixedtotheanterolateralsurfaceofthehumerusbycancellousscrews.Thearmwasimmobilisedfor6weeks.Results:Allthe32patientshadimprovedfunctionwithstabilityoftheshoulder.Theaverageincreaseinactiveabductionwasfrom7.5°(range:0°-30°)to85°(range:45°-°),andthemeanforwardflexionincreasedfrom5.63°(range:0°-15°)to55.2°(range:40°-90°)afterameanfollow-upof8.25months.Twenty-fourofthe32patientsratedtheresultasgoodtoexcellentandweresatisfiedwiththeimprovementinstabilityandfunction.FiftyninepointthirtyeightpercentpatientshadMedicalResearchCouncilMusclepower4afterthesurgery.Conclusion:Transferoftheuppertrapeziusmusclewithasegmentoftheclaviclesegmentforaflailshouldercanprovidesatisfactoryfunctionandstabilitywithfewer







































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