Yam A, Fullilove S, Sinisi M, Fox M
Royal National Orthopaedic, Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
J Bone Joint Surg Br. 2009 Apr;91(4):511-6. doi: 10.1302/0301-620X.91B4.22204.
We reviewed 42 consecutive children with a supination deformity of the forearm complicating severe birth lesions of the brachial plexus. The overall incidence over the study period was 6.9% (48 of 696). It was absent in those in Narakas group I (27.6) and occurred in 5.7% of group II (13 of 229), 9.6% of group III (11 of 114) and 23.4% of group IV (18 of 77). Concurrent deformities at the shoulder, elbow, wrist and hand were always present because of muscular imbalance from poor recovery of C5 and C7, inconsistent recovery of C8 and T1 and good recovery of C6. Early surgical correction improved the function of the upper limb and hand, but there was a tendency to recurrence. Pronation osteotomy placed the hand in a functional position, and increased the arc of rotation of the forearm. The supination deformity recurred in 40% (17 of 42) of those treated by pronation osteotomy alone, probably because of remodelling of the growing bone. Children should be followed up until skeletal maturity, and the parents counselled on the likelihood of multiple operations.
我们回顾了42例患有前臂旋后畸形并伴有严重臂丛神经产伤的连续患儿。在研究期间，总体发生率为6.9%（696例中有48例）。在Narakas I组（27.6例）中未出现，在II组（229例中有13例，占5.7%）、III组（114例中有11例，占9.6%）和IV组（77例中有18例，占23.4%）中出现。由于C5和C7恢复不佳、C8和T1恢复不一致以及C6恢复良好导致肌肉失衡，肩部、肘部、腕部和手部总是同时存在畸形。早期手术矫正改善了上肢和手部的功能，但有复发倾向。旋前截骨术使手处于功能位，并增加了前臂的旋转弧度。仅接受旋前截骨术治疗的患儿中，40%（42例中有17例）出现旋后畸形复发，可能是由于生长中的骨骼重塑。应随访患儿直至骨骼成熟，并向家长告知多次手术的可能性。
