肱三头肌长头重建肩外展的解剖与临床应用

目的对肱三头肌长头进行解剖。描述重建肩外展功能的手术方法,并进行临床随访,明确手术的效果。方法对44侧成人上肢标本解剖观察肱三头肌长头起点的性质、血管神经蒂形态、最大游离范围及入肌点部位。对6例臂丛神经损伤患者行肱三头肌长头起点移位重建肩外展功能,术后随访3～11个月,观察临床应用效果。结果肱三头肌长头起点的背侧为肌性,腹侧为腱性,腱性长度为7.6～13.3cm,宽度为1.6～3.4cm。肱三头肌长头血管神经蒂距肌肉起点的距离5.7～11.4cm。神经支配来自桡神经,可分离长度2.9～11.8cm。血供来自肱动脉的19侧,来自肱深动脉的20侧,其它来源5侧。肱动脉来源的血管蒂长1.0～6.0cm,直径为1.6～2.4mm。肱深动脉的血管蒂可分离长度1.5～4.4cm,直径为0.9～2.4mm,分离至肱动脉长度为1.5～6.3cm。神经血管蒂呈多级分支。6例行肱三头肌长头重建肩外展,术后平均随访6.8个月,术前肩外展5°（0°～10°）,术后肩外展77.3°（50°～90°）。结论肱三头肌长头可适用于肩外展功能重建的手术,经术后随访,效果良好。     

斜方肌移位术重建肩外展功能

我们自１９７４年～１９９５年,采用斜方肌带肩峰骨块固定于肱骨大结节及用阔筋膜延长斜方肌固定于三角肌止点的两种术式治疗臂丛神经损伤所致肩外展功能障碍,术后效果满意,报道如下。１　临床资料本组２２例,男１７例,女５例。年龄１５～５７岁。全臂丛神经根性撕脱伤１３例,臂丛神经上干损伤８例,单纯颈５神经根损伤１例。右侧９例,左侧１３例。其中９例曾行膈神经移位至腋神经术,３例曾行颈丛运动神经支移位至腋神经术,余１０例于伤后１～１０年因臂丛神经或三角肌损伤严重,或损伤时间过久而行斜方肌转移术。术后随访到１９例…     

斜方肌移位术重建肩外展功能

臂丛神经损伤导致不能肩外展、行神经手术后功能恢复欠佳或因损伤时间过长（超过２年）丧失了行神经修复手术时机的患者需行外展功能重建术,其中以行斜方肌移位术最多。１９９２年９月～１９９７年９月,我科采用斜方肌带肩峰骨块固定于肱骨大结节来重建臂丛神经损伤后的肩外展功能,共随访１８例。 资料与方法 一、一般资料 本组１８例,男１４例,女４例;左５例,右１３例;年龄１５～５５岁。致伤原因：摔伤及撞伤１６例,锐器割伤１例,产瘫１例。损伤程度：全臂丛根性撕脱伤１１例,臂丛神经上干损伤５例,Ｃ５神经根损伤２例。术前…     

Betaman法斜方肌移位术重建肩外展功能

臂丛神经损伤经过神经修复手术后，患者肩外展功能仍不能恢复，甚至仍有肩关节半脱位者，可用肩周附近有功能的肌肉移位重建肩外展功能。1997年7月。2002年12月，我院采用改良Betaman法斜方肌移位术重建肩外展功能，取得较为满意的疗效。     

改良Batemen法斜方肌移位重建肩外展功能

目的介绍改良斜方肌移位重建肩外展功能的临床应用。 方法根据肩外展运动生物力学原理及斜方肌解剖学特点,采用改良Batemen法（在Batemen法的基础上加用异体肌腱）对3例三角肌恶性肿瘤完全切除术后患者,重建肩外展功能。 结果术后平均随访12个月,按中华医学会手外科学会上肢部分功能评定试用标准评定,优3例,上肢功能评分平均为4.44分。 结论三角肌恶性肿瘤切除术后肩外展功能重建,改良Batemen法斜方肌移位法值得临床推广。     

Mayer法斜方肌移位重建肩外展功能术（三）

Mayer法斜方肌移位,主要是用斜方肌来修复三角肌功能的方法。该方法在游离斜方肌在肩部的止点后,用大腿阔筋膜延长斜方肌,最后将筋膜远端缝合固定于三角肌止点处。利用斜方肌移位重建肩外展功能的另一种方法是Bateman法,其原理与Mayer法相同,方法是将斜方肌连同其肩峰、肩胛冈止点处的截骨片,在肩关节外展90°位下,用2~3枚螺丝钉固定于肱骨大结节附近。此法在操作上较Mayer法困难。     

肱三头肌外侧头移位重建伸腕功能

[目的]报告利用肱三头肌外侧头移位重建伸腕功能的方法及临床疗效。[方法]对2003年6月~2005年1月收治的7例前臂伸屈肌群严重缺血性肌挛缩的患者采用肱三头肌外侧头移位来重建伸腕功能。[结果]术后随访16个月~3年,腕关节背伸能达到平伸位(0°)者2例,0°~30°者4例,超过30°者1例。[结论]用肱三头肌外侧头移位重建伸腕功能简便有效,为特殊情况下伸腕功能重建提供了一种新方法。     

带蒂大圆肌双极移位重建产瘫肩外展功能

目的评价带蒂大圆肌双板移位重建分娩性臂丛神经损伤（产瘫）后肩外展功能的疗效及临床应用前景。方法对9例产瘫后肩外展功能障碍的患儿行带血管神经蒂大圆肌双极移位术重建肩外展功能,并经术后1年以上的随访,观察其临床应用效果。结果9例患儿术前肩外展平均11．2°（0°-30°）,术后肩外展平均75．4°（45°～95°）。按照顾玉东的评定标准评价：优3例,良4例,可2例,优良率为77．8％。结论对于产瘫后肩外展功能障碍者,用带血管神经蒂大圆肌双极移位术重建其肩外展功能是有效而值得临床推广的治疗方法。     

改良Mayer法斜方肌移位重建肩外展功能

目的：介绍应用斜方肌移位治疗肩外展功能障碍的手术方法。方法：根据肩外展运动的生物力学原理,结合斜方肌的解剖学特点,采用改良Mayer法（在Mayer法的基础上加用异体肌腱）对5例臂丛上干损伤肩外展不能者进行治疗。结果：术后平均随访18个月,按中华医学会手外科学会上肢部分功能评定试用标准评定,优3例,良1例,差1例。结论：臂丛上干不可逆损伤所致的三角肌麻痹,如肩关节周围其它肌肉肌力基本正常,采用改良Mayer法斜方肌移位重建肩外展功能是有效的。     

Transfer of trapezius muscle for reconstruction of abduction of the shoulder

INTRODUCTION: After brachial plexus injuries, shoulder function is frequently impaired or lost. For reconstruction of the most important functions muscle transfers are indicated. To restore abduction and external rotation of the shoulder the trapezius muscle transfer is mainly used. PATIENTS AND METHODS: We demonstrate 16 patients with insufficient abduction of the shoulder joint. All patients were treated with the transfer of trapezius muscle (pars horizontalis). We used a modification of the technique of Saha. After the operation, the arm was immobilized in 80 degrees abduction for 6 weeks followed by 10 degrees adduction of the shoulder per week. Afterwards physiotherapy was started. Evaluation was done by the DASH score and Gilbert score. RESULTS: In all cases, an improvement of shoulder mobility was seen, assessed clinically and individually by the patient. The average DASH score was 37.4. For ten patients the results of the operation were very good, good, or satisfactory. Active abduction increased from 15 degrees (0-30 degrees) to 54 degrees (35-80 degrees) postoperatively. The external rotation was 9 degrees (-20-40 degrees) preoperatively and 19 degrees (0-70 degrees ) postoperatively. DISCUSSION: Trapezius muscle transfer for reconstruction of abduction is an easy and practicable method without serious complications. We achieved good stability and functionality of the shoulder. Intensive pre- and postoperative physiotherapy may provide greater improvement of mobility.     

Reconstruction of elbow flexion by transposition of pedicled long head of triceps brachii muscle

A new technique of restored flexion in the elbow joint in an inveterate injury of the brachial plexus is described. The insertion of the long head of the triceps brachii muscle was transferred with an intact nervous and vascular supply to the anterior brachial region and sutured above the radial tuberosity with the insertion tendon of the biceps brachii muscle. The muscle strength three months after surgery according to the muscle test was 4-. Flexion in the elbow joint was possible up to 85 degrees. Extension in the elbow joint was preserved, the muscle strength was 3. Anatomical investigation revealed that the mean length of the nerve of the long head of the triceps was 5.5 cm, the number of terminal branches was 3-4, 70% of the vascular supply was from the brachial artery, the length of the vascular bundle was 3.6 cm. In 33% there was an additional neurovascular hilus which was 2-3 cm distally from the main hilus. The investigation confirms that the neurovascular pedicle of the long head of the triceps brachii muscle is sufficiently mobile and damage by traction during transposition of the insertion tendon is therefore not likely. Transfer of the long head of the triceps brachii muscle in inveterate injuries of the brachial plexus is a suitable alternative for reconstruction of nerves or transfer of other muscles to restore flexion in the elbow joint.     

Adduction contracture of the shoulder due to fibrous long head of the triceps in children

Objective  To evaluate the clinical and functional results of surgical treatment for fibrous long head of the triceps in children. Materials and methods  Data were analyzed from 32 patients (38 shoulders) aged over 5 years of age from August 1995 to December 2004. The adduction contracture, elbow flexed angles when the scapula was held in the chest wall, and scapulo-humeral angles in radiographs were measured. Surgical release of the long head of the triceps was performed. Results  There were 22 females and 10 males in this study. Bilateral shoulder involvement was found in six patients. Only the right shoulder was involved in 5 patients, and only the left in 21 patients. All 32 patients (38 shoulders) developed adduction contracture of the shoulder after repeated intramuscular injection of antibiotic(s) into the long head of the triceps. Thirty-four shoulders (29 patients) were classified as severe, and four shoulders (3 patients) were classified as moderate. In all, we attained excellent results in 36 shoulders (94.7%) and good results in two shoulders (5.3%). There have been no fair or poor results or complications so far. Conclusion  Generally, surgical treatment of adduction contracture of the shoulder has achieved good results, with improved shoulder function. Releasing the long head of the triceps is a simple and safe surgical technique.     

Restoration of shoulder abduction in brachial plexus injury with phrenic nerve transfer

BACKGROUND: Shoulder abduction is one of the most essential functions in reconstruction of the brachial plexus following injury. In the literature there are few reports on phrenic nerve transfer, especially in relation to restoration of shoulder function. The purpose of the present study was to evaluate the clinical effectiveness and safety of phrenic nerve transfer. METHODS: A study was made of 10 cases of phrenic nerve transfer to the suprascapular nerve. RESULTS: The average shoulder abduction was 41 degrees (range: 20-60 degrees). The average degree of shoulder abduction in patients with C5 or C6 root avulsions was slightly more than that in the patients with total root avulsions. There was no clinically significant respiratory insufficiency in any patient. CONCLUSIONS: Phrenic nerve transfer to the suprascapular nerve is an effective, reliable and safe method of shoulder abduction restoration in brachial plexus injury.     

Humeral head translation during glenohumeral abduction following computer-assisted shoulder hemiarthroplasty

This study compared the effect of a computer-assisted and a traditional surgical technique on the kinematics of the glenohumeral joint during passive abduction after hemiarthroplasty of the shoulder for the treatment of fractures. We used seven pairs of fresh-frozen cadaver shoulders to create simulated four-part fractures of the proximal humerus, which were then reconstructed with hemiarthroplasty and reattachment of the tuberosities. The specimens were randomised, so that one from each pair was repaired using the computer-assisted technique, whereas a traditional hemiarthroplasty without navigation was performed in the contralateral shoulder. Kinematic data were obtained using an electromagnetic tracking device. The traditional technique resulted in posterior and inferior translation of the humeral head. No statistical differences were observed before or after computer-assisted surgery. Although it requires further improvement, the computer-assisted approach appears to allow glenohumeral kinematics to more closely replicate those of the native joint, potentially improving the function of the shoulder and extending the longevity of the prosthesis.     

Applying transfer of trapezius and/or latissimus dorsi with teres major for reconstruction of abduction and external rotation of the shoulder in obstetrical brachial plexus palsy

To evaluate the effects of transfer of the trapezius and/or latissimus dorsi with the teres major for treatment of dysfunction of the shoulder in obstetrical brachial plexus palsy (OBPP), 34 patients with paresis of the abductors and external rotators, as well as co-contraction of the adductors in abduction, who had undergone reconstructive operations, were followed-up for at least 1 year. Of these, transfer of the latissimus dorsi with attached teres major to the insertion of the infraspinatus (single procedure), was performed in 25 cases, and transfer of both latissimus dorsi with teres major and trapezius (to the humerus) in nine (combined procedure). Gilbert's grading system was used for evaluation. The results showed that in spite of improvement of external rotation in most of the cases, abduction was improved in only 13 of the 25 cases with a single procedure, and that eight of nine cases with a combined procedure gained improvement of both external rotation and abduction. These results indicated that, for improvement of both abduction and external rotation of the shoulder in OBPP, transfer of the latissimus dorsi with the teres major can be performed only when abduction is > or =90 degrees; otherwise, transfer of the trapezius should be added.     

Intramuscular pressure and electromyography in the supraspinatus muscle at shoulder abduction

In ergonomic and biomechanic research, estimations of shoulder muscle load and evaluation of different measuring techniques are important. Intramuscular pressure (IMP), using the microcapillary infusion technique and bipolar intramuscular electromyography (EMG), was recorded from the same part of the supraspinatus muscle. In 12 subjects, IMP and EMG were recorded at shoulder abduction angles of 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 135 degrees with no or a 1- or 2-kg hand load in each position. The shoulder torque was calculated for each test position. A correlation was found for both mean IMP and mean EMG versus shoulder torque if the position with extreme muscle shortening (135 degrees abduction) was excluded. IMP was high (greater than 50 mmHg) in almost all test situations. In seven other subjects, isometric force in abduction was correlated with IMP and EMG. Both methods showed an equally good correlation with external shoulder force, IMP gives as good an estimation of relative muscle force as EMG, but any comparison between EMG and IMP must be done at the same muscle length.