Modification Of The Spinal Accessory Nerve Transfer For Treatment Of The Brachial Plexus Injury To Restore Shoulder Abduction: A Basic And Clinical Study

Preface: The shoulder play an important role in developing the function of the upper limb. Which makes the restoration of shoulder function in brachial plexus injury is vital for the functional restoration of the whole upper limb, and has been considered as one of the function which should be restored firstly;The spinal accessory nerve is one of the most effectively and usually used donor nerves for restoration of shoulder abduction. The aim of the study is to improve the outcomes of shoulder abduction by accessory nerve transfer from the following two aspects: ① Select the best choice of recipient nerve;②Design a dorsal-approach spinal accessory nerve transfer, more effevtively use the pinal accessory nerve. Part OneA Clinical and Comparative Study on the Choice of Recipient Nerve of the Spinal Accessory Nerve Transfer for Restoration of Shoulder Abduction in Brachial Plexus InjuryObjective To explore the best choice of recipient nerve for spinal accessory nerve transfer for restoration of the shoulder abduction in brachial plexus injury. And, to observe the affection of the trapezius function after operation. Materials and Methods 46 cases with brachial plexus injury underwent traditional spinal accessory nerve transfer to restore shoulder abduction were followed-up. Recipient nerve: suprascapular nerve in 35 cases (upper partial brachial plexus injury 21 cases and total brachial plexus injury 14 cases), axillary nerve in 11 cases(upper partial brachial plexus injury 5 cases and total brachial plexus injury 6 cases); And trapezius muscle function was measured by physical examination and electrophysiological study in 18 patients. Results Followed-up for 25~37 months (average 27.5 months), the fisrt signs of reinnerveation of suprascapular nerve appeared at 5~12 months,average 9.94±3.26 months,that of axillary nerve appeared at 9~15months, average12.60±3.08 months;The results in patients with suprascapular nerve as recipient(upper partial 57.08±21.16°, total 40.71±14.27°) were significantly better than that in patients with axillary nerve as recipient(upper partial 31.25±20.97°, total 18.75±7.50°). And the muscular function in upper, middle and lower portions of trapezius are affected due to nerve transfer. Conclusions Outcomes in patients with suprascapular nerve as recipient was significantly better than that in patients with axillary nerve as recipient, So the suprascapular nerve should be selected as the best choice of recipient; And functional deficit occured in upper, middle and lower portions of trapezius after the traditional spinal accessory nerve transfer.