Nath R K, Paizi M
Texas Nerve and Paralysis Institute, 2201 West Holcombe, Boulevard, Houston, Texas 77030, USA.
J Bone Joint Surg Br. 2007 May;89(5):620-6. doi: 10.1302/0301-620X.89B5.18403.
Residual muscle weakness in obstetric brachial plexus palsy results in soft-tissue contractures which limit the functional range of movement and lead to progressive glenoid dysplasia and joint instability. We describe the results of surgical treatment in 98 patients (mean age 2.5 years, 0.5 to 9.0) for the correction of active abduction of the shoulder. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). The transferred muscles were sutured to the teres minor muscle, not to a point of bony insertion. The mean pre-operative active abduction was 45 degrees (20 degrees to 90 degrees ). At a mean follow-up of 4.8 years (2.0 to 8.7), the mean active abduction was 162 degrees (100 degrees to 180 degrees ) while 77 (78.6%) of the patients had active abduction of 160 degrees or more. No decline in abduction was noted among the 29 patients (29.6%) followed up for six years or more. This procedure involving release of the contracted internal rotators of the shoulder combined with decompression and neurolysis of the axillary nerve greatly improves active abduction in young patients with muscle imbalance secondary to obstetric brachial plexus palsy.
产科臂丛神经麻痹导致的残留肌肉无力会引起软组织挛缩，限制运动功能范围，并导致进行性关节盂发育不良和关节不稳定。我们描述了98例（平均年龄2.5岁，0.5至9.0岁）因纠正肩部主动外展而接受手术治疗的结果。患者接受了背阔肌和大圆肌转移、肩胛下肌、胸大肌和胸小肌挛缩松解以及腋神经减压和神经松解术（改良Quad手术）。转移的肌肉缝合到小圆肌上，而不是骨性附着点。术前平均主动外展角度为45度（20度至90度）。平均随访4.8年（2.0至8.7年）时，平均主动外展角度为162度（100度至180度），77例（78.6%）患者的主动外展角度达到160度或以上。在随访6年或更长时间的29例患者（29.6%）中，未发现外展角度下降。这种涉及松解肩部内旋挛缩肌肉并结合腋神经减压和神经松解的手术，能显著改善因产科臂丛神经麻痹继发肌肉失衡的年轻患者的主动外展功能。
