中華民國骨科醫學會 107 年度第 75 次聯合學術研討會投稿摘要用紙

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論 文 分 類 ： □Adult Recon □Pediatrics ■Hand □Sports □Trauma □Research
□Spine □Tumor □Foot-Ankle □Infection □Knee Arthroscopy
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題目（Title）Double nerve transfer for shoulder function reconstruction in upper arm type brachial
plexus injury: case report and literature review
作者（Author） 許芳偉 楊鎮源 李芳材 王迺輝 王乃弘
單位（Organization）光田綜合醫院 骨科部

【Introduction】
In upper arm type brachial plexus injury, shoulder function impairment mainly results from
denervated deltoid muscle and rotator cuff muscles. This case report demonstrates the effectiveness of
double nerve transfer method in shoulder function reconstruction.
【Materials and Methods】
A 37 y/o man sustained multiple trauma including brain concussion, renal/liver contusion, clavicle
fracture, and scapula fracture in a severe traffic accident. After receiving ORIF for clavicle fracture, he
was referred to our hospital under the impression of upper arm type brachial plexus injury. PE found
deltoid muscle and rotator cuff atrophy with muscle power around M1-2 despite rehabilitation for 3
months. During operation, neurolysis of brachial plexus was done due to severe adhesion. Electric
stimulation showed strong biceps and triceps muscle contraction but no response over deltoid muscle
and rotator cuff muscles. Therefore, spinal accessory nerve was transferred to suprascapular nerve
within same supraclavicular approach and then under posterior approach, radial nerve triceps branch
was transferred to axillary nerve anterior branch toward deltoid muscle. After double transfer,
rehabilitation program with passive and active range of motion exercise was initiated. The functional
outcome was reviewed every month and EMG/NCV was arranged every 3 months post-operatively.
【Results】
After follow-up for 2 years, this patient recovered full range of forward elevation, abduction and
external rotation with M3 power, and can achieve abduction 135° with M4 power (carrying 2kg water
bottle). Useful functional recovery was achieved. No notable weakness of elbow extension was
observed.
【Discussion】
Using spinal accessory nerve transfer to suprascapular nerve to restore basic shoulder function is
standard treatment procedure in upper arm type brachial plexus injury. Since 2003, professor Somsak
publish serial studies confirming it a reliable and effective procedure if deltoid muscle function is
further restored by nerve transferred from radial nerve triceps branch to axillary nerve. Use triceps
medial head or long head branch could both recover good function without prominent donor site
morbidity
【Conclusions】
Double nerve transfer combining spinal accessory nerve transfer to suprascapular nerve and radial
nerve triceps branch transfer to axillary nerve could achieve satisfactory functional results for shoulder
function reconstruction in upper arm type brachial plexus injury

代表作者服務單位：光田綜合醫院 骨科部
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