Isolated latissimus dorsi transfer to restore shoulder external rotation

Bone Joint J 2013;95-B:660-3.
成人腕神経叢損傷における肩関節外旋機能回復のための広背筋単独移行術
Isolated latissimus dorsi transfer to restore shoulder external rotation in
adults with brachial plexus injury
By S. Ghosh, D.Orth, MRCSEd, FRCS(Tr & Orth)*, V.K. Singh, MRCS, MCh, DIPSEM,
L. Jeyaseelan, MRCS, M. Sinisi, MD, and M. Fox, FRCS(Tr & Orth)**
要　約：
Abstract:
In adults with brachial plexus injuries, lack of active
external rotation at the shoulder is one of the most common residual deficits, significantly compromising upper
limb function. There is a paucity of evidence to address
this complex issue. We present our experience of isolated
latissimus dorsi (LD) muscle transfer to achieve active
external rotation. This is a retrospective review of 24
adult post-traumatic plexopathy patients who underwent
isolated latissimus dorsi muscle transfer to restore external rotation of the shoulder between 1997 and 2010. All
patients were male with a mean age of 34 years (21 to 57).
All the patients underwent isolated LD muscle transfer
using a standard technique to correct external rotational
deficit. Outcome was assessed for improvement in active
external rotation, arc of movement, muscle strength and
return to work. The mean improvement in active external
rotation from neutral was 24° (10° to 50°). The mean
increase in arc of rotation was 52° (38° to 55°). Mean
power of the external rotators was 3.5 Medical Research
Council (MRC) grades (2 to 5).
A total of 21 patients (88%) were back in work by the
time of last follow up. Of these, 13 had returned to their
pre-injury occupation. Isolated latissimus dorsi muscle
transfer provides a simple and reliable method of restoring useful active external rotation in adults with brachial
plexus injuries with internal rotational deformity.
成人腕神経叢損傷例では，肩関節の自動外旋の制限は
もっとも頻度の高い後遺障害の 1 つであり，これによっ
て上肢機能が著しく損なわれる．この複雑な問題を解決
するためのエビデンスは不足している．われわれは自動
外旋運動を回復するための広背筋単独移行術の経験を示
す．本研究は，1997 〜 2010 年に肩関節外旋運動の回
復のために広背筋単独移行術を受けた，外傷後神経叢損
傷の成人患者 24 例に関する後ろ向き調査である．患者
は全例男性で平均年齢は 34（21 〜 57）歳であった．すべ
ての患者が外旋障害を改善するために標準的な手技を用
いた広背筋単独移行術を受けた．自動外旋運動，可動域，
筋力の改善，および復職を評価項目とした．中間位から
の自動外旋運動の改善の平均は 24°
（10°〜 50°
）であっ
た．可動域の増加の平均は 52°
（38°〜 55°
）であった．
外旋時の筋力の平均は Medical Research Council
（MRC）
スコアで 3.5（2 〜 5）であった．
計 21 例（88%）の患者が最終追跡調査時までに仕事を
再開していた．このうち 13 例は受傷前の職業に復帰し
た．広背筋単独移行術は，内旋変形がみられる成人腕神
経叢損傷例に対して，自動外旋運動を回復させるための
簡易かつ信頼性の高い方法である．
* Consultant Surgeon Royal National Orthopaedic Hospital,
Peripheral Nerve Injury Unit, Brockley Hill, Stanmore,
Middlesex HA7 4LP, UK.
** E-mail: [email protected]
Table I. Demographic data
Characteristic
Patients (n)
Male (n, %)
Mean age (yrs) (range)
Affected side (n, %)
Right
Left
Dominant side (n, %)
Right
Left
Unknown
Occupation (n, %)
Office-based
Heavy manual
24
24 (100)
34 (21 to 57)
17 (71)
7 (29)
17 (71)
4 (17)
3 (13)
8 (33)
16 (67)
Reproduced with permission and copyright of The British Editorial Society of Bone and Joint Surgery [Bone Joint J 2013;95-B:661]

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