Waters P M, Peljovich A E
Department of Orthopedic Surgery, Childrens Hospital Medical Center, Harvard Medical School, Boston, MA 02115, USA.
Clin Orthop Relat Res. 1999 Jul(364):144-52. doi: 10.1097/00003086-199907000-00019.
Patients with chronic brachial plexus birth palsy and persistent peripheral neurologic deficits frequently have problems related to their shoulder. Specifically, internal rotation and adduction contractures develop because of the loss of muscle balance about the glenohumeral joint. With time, progressive and predictable deformity of the glenohumeral joint occurs. The authors reviewed their results in treating patients with persistent functional deficits with either soft tissue procedures (tendon transfers and muscle releases) or rotational humeral osteotomies based on criteria incorporating patient age and degree of glenohumeral deformity. Patients in each group were evaluated prospectively and compared with each other. In all cases, patients in both groups experienced substantial improvements in global shoulder function. In the patients in the tendon transfer group, global Mallet scores improved from an average of 9.5 to 15.6. Patients undergoing humeral osteotomies also had improvements in global Mallet score from an average of 9.5 to 15.1. This study confirms that both operations, when appropriately applied, will predictably improve shoulder function.
患有慢性臂丛神经产瘫及持续性周围神经功能缺损的患者，肩部常常出现问题。具体而言，由于盂肱关节周围肌肉平衡丧失，会出现内旋和内收挛缩。随着时间推移，盂肱关节会发生渐进性且可预测的畸形。作者根据纳入患者年龄和盂肱关节畸形程度的标准，回顾了他们采用软组织手术（肌腱转移和肌肉松解）或肱骨旋转截骨术治疗存在持续性功能缺损患者的结果。对每组患者进行前瞻性评估并相互比较。在所有病例中，两组患者的整体肩部功能均有显著改善。肌腱转移组患者的Mallet总分平均从9.5分提高到15.6分。接受肱骨截骨术的患者Mallet总分也从平均9.5分提高到15.1分。这项研究证实，这两种手术在恰当应用时，均可预期改善肩部功能。
