Clinical Study On The Effect Of Paraspinal Muscle Branch Retention On Shoulder Function In Neck Dissection

[Objective]To evaluate the effect of trapezius branch of accessory nerve damage in the neck dissection on the recovery of postoperative neck and shoulder function,and study the role of the trapezius branch in the recovery of postoperative shoulder function.Provide a reference for the positioning and protection of the paraspinal muscle branch in the neck dissection.[Methods]We selected 98 head and neck cancer cases which were treated with neck dissection in the Qilu Hospital of Shandong University form January 2017 to June 2018.Based on different surgical methods of descending branch hypoglossal nerve,the patients were divided into three groups(ABC).Group A includes 52 cases with completely preservation of the accessory nerve and its branches such as sternocleidomastoid branch and trapezius branch.Group B consisted of 29 cases,which protected the trapezius branch during operation,but disconnected the sternocleidomastoid branch and other small branches.Group C includes 17 cases with disconnection of the accessory nerve and its branches.Evaluation of trapezius muscle atrophy and recovery of neck and shoulder function in patients were performed from six months to one year after surgery.All data is processed by SPSS22.0.Preoperative data include age,gender,primary tumor location and pathology.Shoulder function evaluation includes subjective questionnaire and objective indicators which are analyzed with Nonparametric Tests.[Results]All 98 patients were performed selective neck dissection and primary cancer resection.The operation was successful and there were no deaths during the perioperative period.By comparing and analyzing the clinical data of the three groups,it can be found that there was no signi:ficant difference between three groups in preoperative general data.The evaluation of postoperative shoulder function in groups A and B was significantly better than that in group C.There was no significant difference in shoulder function evaluation between groups A and B.There was no statistical difference in radiotherapy effects between groups.[Conclusion]The shoulder syndrome after neck dissection is mainly related to the preservation of the trapezius branch of the accessory nerve during the operation.Radiotherapy has little effect on shoulder syndrome.The completely preservation of the accessory nerve can effectively reduce the occurrence of postoperative shoulder syndrome.Only retaining the trapezius branch can also significantly reduce the incidence of shoulder syndrome,even if there is difficulty in turning neck,the impact on the quality of life of patients is also limited.If the trapezius branch of the accessory nerve is damaged,there will be obvious symptoms such as shoulder pain,sagging shoulder and decreased shoulder mobility,and seriously affect the quality of life of patients.So protecting the trapezius branch is very important in neck dissection.