Department of Orthopaedic Surgery, Temple University & Hand Surgeon, Shriners Hospital for Children, Philadelphia, PA 19140, USA.
J Shoulder Elbow Surg. 2010 Jan;19(1):102-10. doi: 10.1016/j.jse.2009.05.011.
The purpose of the study was to assess the ability of arthroscopic anterior release, +/- tendon transfers to maintain shoulder joint alignment in children with brachial plexus palsy, and to assess their outcome after arthroscopic reduction.
Forty-four patients underwent arthroscopic release, +/- tendon transfers to realign a dysplastic glenohumeral joint in children with brachial plexus palsy. Twenty-eight children underwent isolated release and 16 children underwent concomitant tendon transfers. MRI and clinical measurements were used to assess outcome at 1-year follow-up.
There was a significant improvement (P < .001) in both retroversion from -34 (+/-15) to -19 (+/-13), and percentage of the humeral head anterior to the middle of the glenoid fossa (PHHA) from 19% (+/-12%) to 33% (+/-12%), at 1 year. Passive external rotation increased from -26 (+/-20) degrees to 47 (+/-17) degrees (P < .001). Active elevation increased from 112 (+/-28) degrees to 130 (+/-38) (P = .008) degrees. Patients that underwent tendon transfers obtained greater active elevation, 147 (+/-9) degrees compared to 119 (+/-6) degrees. Mallet aggregate and domain scores also demonstrated statistically significant improvements.
Our results after arthroscopic release +/- tendon transfers are encouraging with improvements in joint alignment and clinical evaluations following surgery. The clinical improvements paralleled the MRI corrections. Importantly, superior outcomes were associated with better preoperative clinical and MRI status. This indicates that early recognition of glenohumeral dysplasia and timely intervention results in better shoulder motion and improved joint alignment.
本研究旨在评估关节镜下前松解术联合/不联合肌腱转移术治疗臂丛神经损伤患儿肩关节发育不良的能力，并评估关节镜下复位后的疗效。
44 例臂丛神经损伤患儿接受了关节镜下松解术联合/不联合肌腱转移术以矫正发育不良的盂肱关节。28 例患儿行单纯松解术，16 例患儿行联合肌腱转移术。采用 MRI 和临床测量评估术后 1 年的疗效。
术后 1 年，肩胛骨旋转角由术前的-34°（+/-15°）显著改善至-19°（+/-13°）（P <.001），肱骨头前突百分比由术前的 19%（+/-12%）显著改善至 33%（+/-12%）（P <.001）。被动外旋由术前的-26°（+/-20°）显著增加至 47°（+/-17°）（P <.001）。主动抬高由术前的 112°（+/-28°）显著增加至 130°（+/-38°）（P =.008）。行肌腱转移术的患儿获得了更大的主动抬高角度，为 147°（+/-9），而单纯松解组为 119°（+/-6）。Mallet 评分和功能域评分也显示出统计学上的显著改善。
关节镜下松解术联合/不联合肌腱转移术的疗效令人鼓舞，术后关节对线和临床评估均有改善。临床改善与 MRI 矫正结果一致。重要的是，术前临床和 MRI 状态较好与更好的术后结果相关。这表明，早期识别盂肱关节发育不良并及时干预可获得更好的肩部运动和关节对线。
4 级
