| Objective: 1.Observe and summarize the clinical efficacy of the suprascapular nerve transposition of the accessory nerve;2.Evaluate the clinical efficacy of the suprascapular nerve transposition of the accessory nerve after the injury,and analyze and summarize the indications of the injured accessory nerve as the motive nerve.Methods: From January 2012 to December 2020,93 cases of traumatic brachial plexus injury in which the accessory nerve was transferred to the suprascapular nerve were collected,and 61 cases were followed up.61 patients with traumatic brachial plexus injury were divided into two groups according to the status of the accessory nerve before operation: 30 patients with no accessory nerve injury(group A),28 males and 2 females,with an average age of(28.91±13.77)years old,2 cases of surgical approach were anterior approach,28 cases of surgical approach were posterior approach;31 patients with functional recovery after accessory nerve injury(group B),30 males and 1 female,average age(29.90)±13.41)years old,2 cases of surgical approach were anterior approach,and 29 cases of surgical approach were posterior approach.Follow-up to observe the time required to improve the postoperative shoulder subluxation,the time of shoulder abduction,the time required to restore the shoulder abduction to the maximum angle,the improvement of the shoulder abduction angle and the shoulder abduction muscle strength,and the ASES score.Compare the size of each index for analysis.Results: Among 61 patients with traumatic brachial plexus injury,55 patients had improved shoulder subluxation,the recovery rate was about 90.2%,and the improvement time was 3.18±1.04 months..The improvement time of shoulder subluxation in group A and group B was 3.11±0.93 months and3.25±1.14 months,which was not statistically significant;The appearance time of shoulder abduction movements in group A was 3.63±1.31 months,and the appearance time of shoulder abduction movements in group B was 4.70±1.90 months.The comparison between the two groups was statistically significant(P<0.05);The time for shoulder abduction to the maximum angle in group A was21.50±9.65 months,and the time for shoulder abduction to the maximum angle in group B was 27.91±10.48 months,which was statistically significant between the two groups(P<0.05).The shoulder abduction angle of all cases was 16.29°±14.19°for the first half of the operation,33.65°±30.79° for the first year after the operation,45.00°±32.84° for the two years after the operation,and 48.71°±36.47°for the three years after the operation.The shoulder abduction angles of all cases were analyzed statistically at each time period after surgery(P<0.05),which was statistically significant;There was no statistically significant comparison of shoulder abduction angles in groups A and B at various time periods after surgery;There was no statistically significant comparison of shoulder abduction angles in groups A and B at various postoperative time periods;With the prolongation of postoperative recovery time,the proportion of M4 muscle strength in all cases,group A,and group B gradually increased.The proportion of M4 muscle in group B was higher than that in group B at each postoperative period,and the proportion of M4 muscle strength was not much different between the two after three years.The ASES scores of all cases were(79.14±14.59)points,and the ASES scores of group A and group B were(79.90±14.66)points and(79.38±14.77)points respectively.There was no significant difference(P>0.05).Conclusion : For patients with shoulder joint dysfunction caused by traumatic brachial plexus injury: 1.The suprascapular nerve transfer from the posterior approach is the best surgical procedure for restoring shoulder joint function;2.The auxiliary nerve recovered after the injury can still be used as a transplant.It is the power nerve of the suprascapular nerve. |
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