Posterior Approach For Accessory-Suprascapular Nerve Transfer: A Electroneurophysiological Analysis

Introduction:Accessory-Suprascapular Nerve Transfer is the classics operation for the brachial plexus roots avulsion injuries.The conventional anterior approach is popular now,but sometimes the anterior approach can't obtain suprascapular nerve because the brachial plexus is pulled down behind to the clavicle for the serious injury and the great force.The posterior approach,newly rised these years,accepted by surgeons gradually for its quickly recovery and tiny injury to trapezius.Sometimes the posterior approach can take place of the anterior one,but the effect hadn't bee reported yet.Now we compared 35 patients of posterior approach with 39 patients of anterior approach by electromyography after operation.Objective To study the recovery of the posterior approach for Accessory-Suprascapular Nerve Transfer by electromyography,compared to the conventional anterior approach.Methods From 2001.1 to 2008.7,35 patients treated with posterior approach for Accessory-Suprascapular Nerve Transfer and 39 patients treated with anterior way, then we followed up for their electromyographic record.Results(1) The time the suprascapular never treated with the posterior approach started to have motion unit and simple phase has no difference from the anterior way. The result shows there is no difference in these two groups for the infraspinatus' early recovery.(2)The rates of the patients appear to have neogenetic potential have no difference in these two groups.The result shows there is no difference in these two groups for the infraspinatus' final recovery(3) Every following-up,we get the patients' electromyographic record,including the latency(T) and wave amplitude(F) of the compound muscular action potential, and these two parameters have a linear correlation with the time post-operation in posterior approach:F=0.04897+0.1289t,T=14.356-0.3591t。Conclusion The recovery by the posterior approach for Accessory-Suprascapular nerve transfer has no difference from the anterior way by electromyography after operation.Discussion This Conclusion has great difference from the tradition that the posterior approach had quick recovery,we analyzed and get some reasons:1.the brachial plexus is pulled down behind to the clavicle for the serious injury and the great force, so the surgeon abandon the anterior approach and prefer the posterior way,which also cause a long time to the next operation.2.beside the brachial plexus roots completely avulsion,the severe injury can also cause the scapular fracture,upper limb fracture, rotator cuff injury,which can be result in the instability of the should and the nerve growing bad.3.After injury the accessory nerve was disfuction,finally it gradually recover and do the posterior approach,but the injuried accessory nerve provid less motive fibrilla.