| Purpose this study via observes the functional recovery of shoulder abduction and change of the innervation of trapezius after transfering the spinal accessory nerve to suprascapular nerve through the dorsal approach. And explore the advantages of this technique and the influence factors.Method 342 patients with brachial plexus injury were diagnosised and treated in our department from January 2006 to April 2012. And 86 patients needed transfer spinal accessory nerve to the suprascapular nerve repairing for shoulder abduction, and final 65 cases were done. We observed the functional recovery of shoulder abduction and change of the innervations of the trapezius after transferring.Results Finally a total of 54 patients could achieve at least 1 months of follow-up, while 11 cases were lost. The time ranged between 1 and 36 months. Shoulder subluxation improvement appeared early at 3.5±1.5 months, and it’s recovery rate is 94%. At 6 moths post-reconstruction shoulder adduction reached 15.4°±11.0°,compared with 40.5±20.2,45.5±18.0,47.2±20.4 at 12,24 and 36 months. At 6 months post-reconstruction,45 patients achieved M3 force of abduction and 5 of M4, compared with 31,10 and 8,20 and 0,19 at 12,24 and 36 months post-reconstruction. The upper and middle trapezius did not change significantly, while the lower lost muscle force. No one experienced neck and shoulder pain.Conclusion transfer of the spinal accessory nerve to suprascapular nerve through dorsal scapular approach is a new and reliable technique in restoring shoulder abduction.1 It makes full use of the length of the nerve in deep of the trapezius, being close proximity to the affected muscles, to facilitates an early recovery.2 It ensures better preservation of the function of upper trapezius compared with the anterior approach.3. Shoulder abduction was about 1-1.5 years to achieve the best in postoperative recovery with proper functional training, while as time extended and improved. |
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