Pearl Michael L
Kaiser Permanente, Los Angeles Medical Group, Los Angeles, CA 90027, USA.
J Am Acad Orthop Surg. 2009 Apr;17(4):242-54. doi: 10.5435/00124635-200904000-00005.
Traction injury to the brachial plexus sustained during the birth process that results in impaired neuromuscular function of the upper extremity continues to occur despite advances in modern obstetric care. The most common pattern of injury usually results in motor weakness of shoulder external rotation, leading to internal rotation contractures and subsequent deformity of the skeletally immature glenohumeral joint. Understanding of these deformities and effective surgical intervention have advanced greatly over the past decade. Restoration of balance between internal and external rotation forces around the shoulder has great potential for remodeling of the glenohumeral joint in the young child. Arthroscopic-directed release of the contracture, with select use of latissimus dorsi transfer to provide external rotation power, has proved to be effective for many children with these contractures.
尽管现代产科护理有所进步，但分娩过程中臂丛神经受到的牵引损伤仍会导致上肢神经肌肉功能受损。最常见的损伤模式通常会导致肩部外旋肌无力，进而导致内旋挛缩以及骨骼未成熟的盂肱关节随后出现畸形。在过去十年中，对这些畸形的认识和有效的手术干预有了很大进展。恢复肩部内外旋力量之间的平衡对于幼儿盂肱关节的重塑具有很大潜力。关节镜引导下的松解挛缩，并选择性地使用背阔肌转移来提供外旋动力，已被证明对许多患有这些挛缩的儿童有效。
