Moukoko Didier, Ezaki Marybeth, Wilkes David, Carter Peter
Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA
J Bone Joint Surg Am. 2004 Apr;86(4):787-93. doi: 10.2106/00004623-200404000-00018.
Glenoid dysplasia and posterior shoulder subluxation with resultant shoulder stiffness is a well-recognized complication in infants with neonatal brachial plexus palsy. It is generally considered to be the result of a slowly progressive glenohumeral deformation secondary to muscle imbalance, physeal trauma, or both. Recent publications about infantile posterior shoulder dislocation have suggested that the onset of dysplasia occurs at an earlier age than has been previously recognized. The prevalence of early dislocation in infants with this disorder has not been previously reported, to our knowledge.
We studied 134 consecutive infants with neonatal brachial plexus palsy who were seen at our institution over a period of two years. All infants were examined at monthly intervals to assess neurological recovery and the status of the upper extremity until recovery occurred or a treatment plan was established. The type of brachial plexus involvement was classified. Specific clinical signs associated with subluxation and dislocation were recorded. These included asymmetry of skin folds of the axilla or the proximal aspect of the arm, apparent shortening of the humeral segment, a palpable asymmetric fullness in the posterior region of the shoulder, or a palpable click during shoulder manipulation. The infants who were identified as having these clinical signs were evaluated with ultrasonographic imaging studies.
Eleven (8%) of the 134 infants had a posterior shoulder dislocation. The mean age at the time of diagnosis was six months (range, three to ten months). There was no correlation between the occurrence of dislocation and the type of initial neurological deficit. A rapid loss of passive external rotation between monthly examinations indicated a posterior shoulder dislocation.
Posterior shoulder dislocation can occur earlier (before the age of one year) and more rapidly in infants with neonatal brachial plexus palsy than has been appreciated previously. As with developmental dysplasia of the hip, a high index of suspicion, recognition of clinical signs, and the use of ultrasonography will allow the diagnosis to be established. Following early diagnosis, attention should be focused on improving the stability and congruency of the shoulder joint.
盂肱关节发育不良及后肩关节半脱位并导致肩关节僵硬是新生儿臂丛神经麻痹婴儿中一种公认的并发症。通常认为这是继发于肌肉失衡、骨骺创伤或两者的缓慢进展性盂肱关节变形的结果。最近关于婴儿后肩关节脱位的出版物表明，发育不良的发病年龄比以前认识到的要早。据我们所知，此前尚未报道过患有这种疾病的婴儿早期脱位的患病率。
我们研究了在两年期间于我们机构就诊的134例连续性新生儿臂丛神经麻痹婴儿。所有婴儿每月接受检查，以评估神经恢复情况和上肢状况，直至恢复或制定治疗计划。对臂丛神经受累类型进行分类。记录与半脱位和脱位相关的特定临床体征。这些体征包括腋窝或上臂近端皮肤褶皱不对称、肱骨干明显缩短、肩部后方可触及的不对称饱满感或肩部手法检查时可触及的弹响。对被确定有这些临床体征的婴儿进行超声成像检查。
134例婴儿中有11例（8%）发生后肩关节脱位。诊断时的平均年龄为6个月（范围3至10个月）。脱位的发生与初始神经功能缺损类型之间无相关性。每月检查之间被动外旋的快速丧失表明后肩关节脱位。
新生儿臂丛神经麻痹婴儿的后肩关节脱位可能比以前认识到的更早（在1岁之前）且更迅速地发生。与发育性髋关节发育不良一样，高度的怀疑指数、对临床体征的认识以及超声检查的使用将有助于确诊。早期诊断后，应将注意力集中在改善肩关节的稳定性和一致性上。
