Trapezius transposition to replace deltoid surgery

Trapepotomy displacement deltoid surgery for advanced upper limb function reconstruction of childbirth brachial plexus injury. Late upper limb functional reconstruction surgery for childbirth brachial plexus injury involves functional reconstruction of the shoulder, elbow, and wrist joints. Compared with adult brachial plexus avulsion injury, brachial plexus injury is relatively light, mostly partial injury, nerve continuity is maintained at the wound, nerve regeneration ability is strong, and most functions recover well. Because the degree of damage of the brachial plexus is different, although the nerve regeneration is better, but it is not synchronized, resulting in imbalance of shoulder muscle strength recovery, shoulder joint dysfunction, mostly manifested as internal rotation contracture deformity and abduction of the shoulder joint, Limited external rotation function; loss of elbow flexion function and wrist function. Treatment of diseases: brachial plexus injury Indication The trapezius muscle displacement deltoid surgery is suitable for: 1. The nerve displacement repairs the scapular nerve and the radial nerve for more than 2 years after the nerve regeneration, and the shoulder abduction muscle strength is below 3. 2. The nerve injury is more than 2 years. The deltoid muscle, the superior and inferior gluteal muscles have obviously shrunk, and there is no abduction or flexion function. 3. The trapezius muscle strength is above grade 3. Contraindications 1. A scapular shoulder deformity caused by extensive paralysis of the muscles of the scapular joint. 2. There are serious obstacles in the hand feeling and movement, and it is impossible to rebuild the function. Preoperative preparation 1. Conventional shoulder joint X-ray film, except for shoulder dislocation. 2. If there is a deformity of the internal rotation of the shoulder joint, passive activity training or plaster orthosis should be performed. Surgical procedure Incision Along the scapula to the acromion, it is curved to the inner lower part and stops at the top of the condyle. Then it extends 6~7cm to the shoulder and upper arm laterally at the shoulder. The whole incision looks like a "Y" shape. 2. Exposing and free trapezius Cut the skin and deep fascia, dissipate the flap properly, and open the atrophic deltoid muscle to reveal the shoulder joint. Free soft tissue under the shoulder and scapula. In addition, oblique osteotomy was performed at the base of the scapula, and the osteotomy line was obliquely outward. Lift the shoulder and scapula attached to the trapezius muscle, and release the trapezius muscle to the proximal end properly, but keep the width of the trapezius muscle. 3. The trapezius muscle moves down and fixes First knock out the lateral end of the clavicle 2cm, do not damage the sacral ligament. The cut shoulders and scapula bones are made rough and uneven. Then, the upper arm is abducted by 90°, and the distal end of the trapezius muscle is attached to the outside and the bone piece is attached. The cortical bone is roughened on the outer side of the upper end of the humerus, the trapezius muscle and the bone piece can be contacted. ~3 screws fix the shoulder and scapular bones attached to the trapezius muscle to the rough part made on the outer side of the upper end of the tibia. 4. Close the incision Maintain a shoulder abduction of 90 °, completely stop bleeding, suture the incision layer by layer.

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