Bedi Asheesh, Miller Bruce, Jebson Peter J L
Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
Tech Hand Up Extrem Surg. 2005 Jun;9(2):113-9. doi: 10.1097/01.bth.0000168165.61469.39.
The treatment of a severe traction injury resulting in complete, posttraumatic brachial plexus palsy remains a daunting challenge to the upper extremity surgeon. Operative intervention must address painful glenohumeral instability while optimizing functional rehabilitation. Glenohumeral arthrodesis has been shown to reliably alleviate pain from shoulder instability and place the extremity in a functional position for activities of daily living. An above the elbow amputation has also been advocated to remove the flail insensate extremity and create a stable stump for prosthetic training and rehabilitation. We describe the technique of a combined glenohumeral arthrodesis and above elbow amputation to address the flail insensate limb following a severe posttraumatic brachial plexus injury. In our clinical experience, the combination of procedures results in an improved pain level, enhances shoulder stability, encourages functional rehabilitation via prosthetic fitting, and is associated with high patient satisfaction.
治疗严重牵引伤导致的完全性创伤后臂丛神经麻痹，仍然是上肢外科医生面临的一项艰巨挑战。手术干预必须解决疼痛性的盂肱关节不稳定问题，同时优化功能康复。盂肱关节融合术已被证明能可靠地减轻肩部不稳定引起的疼痛，并使肢体处于有利于日常生活活动的功能位。也有人主张行肘上截肢术，以切除连枷样无感觉的肢体，并为假肢训练和康复创造一个稳定的残端。我们描述了一种联合盂肱关节融合术和肘上截肢术的技术，用于处理严重创伤后臂丛神经损伤后的连枷样无感觉肢体。根据我们的临床经验，联合手术可改善疼痛程度，增强肩部稳定性，通过假肢适配促进功能康复，且患者满意度高。
