腕神経叢引き抜き損傷に対する肩再建術

Abstract

Shoulder arthrodesis is the most often proposed method for treatment of patients with root avulsion because of limitation of muscles for reconstruction. Although the patient achieves stable joint by this method, this joint becomes very inconvenient in a crowded place. From 1980, in nine patients with flail shoulder, we performed shoulder joint reconstruction using a muscle transfer. Prior to this operation, intercostal nerve transfer had been carried out as elbow flexoplasty in all patients. This paper presents the operative method and results of the muscle transfer.Operative method: With the patient in a lateral decubitus position, the shoulder is approached through a T-shaped incision. The flap is mobilized freely enough to expose the spine of the scapula, the lateral 5cm of clavicle, the acromion and the deltoid muscle. The scapular spine is cut at the base of the acromion and the upper fiber of trapezius with the acromion is freed from the clavicle and scapular spine. The superior angle of the scapula is cut at its base and the levator scapula with the angle is fixed to the lateral part of the scapular spine with a wire. The arm is then abducted to a right angle and the acromion with trapezius is fixed to the humerus as distally as possible. The transferred acromion is fixed by two or three screws.Postoperatively the arm is immobilized in a shoulder spica at 90 degrees of abduction for four to six weeks.Results: At follow-up an average of 34 months after surgery, the mean active elevation angle was 46±16 degrees. The power of elbow flexors was increased to 3 or 4 by MMT due to the increase in stability of the shoulder joint.This operative method may take the place of shoulder arthrodesis for patients with root avulsion as a shoulder reconstructive operation.