Clarke Sylvan E, Chafetz Ross S, Kozin Scott H
Department of Orthopaedic Surgery, Albert Einstein Medical Center, 5501 Old York Road, WCB4, Philadelphia, PA 19141, USA.
J Pediatr Orthop. 2010 Jan-Feb;30(1):60-6. doi: 10.1097/BPO.0b013e3181c6c344.
Children with residual brachial plexus birth palsy may develop deformities of the humeral head and the glenoid. Surgical treatment has been described to maximize function and to lessen deformity by means of glenohumeral remodeling. The timing and technique of surgical intervention have not been resolved. The timing of the appearance on magnetic resonance imaging of the ossific nuclei in patients with brachial plexus birth palsy has not been described. We examined the timing of ossification about the proximal humerus. Our hypothesis was that the timing of ossification of the proximal humerus differs between the side involved in brachial plexus palsy and the uninvolved side.
A retrospective study was performed of 117 children with residual brachial plexus birth palsy (aged 5 mo to 10 y) who had magnetic resonance imaging scans of the bilateral shoulders performed at our institution between 2000 and 2007. All axial slices were reviewed by a single observer for evidence of ossification of the humeral head epiphysis, the greater tuberosity, and the lesser tuberosity, as well as for evidence that the 3 were coalesced. Statistical analysis was performed to compare the involved and uninvolved sides.
The appearance of the greater tuberosity ossific nucleus on the involved side was significantly delayed. There was a trend towards delay in the appearance of the lesser tuberosity ossific nucleus and the coalescence of the 3 ossific nuclei on the involved side. The duration during which ossification of the involved brachial plexus side occurred was generally shorter compared with the uninvolved side.
There is delay in the ossification of the involved side in brachial plexus birth palsy, and a shorter duration of ossification.
患有臂丛神经产瘫后遗症的儿童可能会出现肱骨头和关节盂畸形。已有手术治疗的报道，通过盂肱关节重塑来最大化功能并减轻畸形。手术干预的时机和技术尚未明确。臂丛神经产瘫患者肱骨骨化核在磁共振成像上出现的时间尚未见报道。我们研究了肱骨近端的骨化时间。我们的假设是，臂丛神经麻痹患侧与未患侧肱骨近端的骨化时间不同。
对2000年至2007年期间在我院接受双侧肩部磁共振成像扫描的117例患有臂丛神经产瘫后遗症的儿童（年龄5个月至10岁）进行回顾性研究。由一名观察者对所有轴位切片进行检查，以寻找肱骨头骨骺、大结节和小结节骨化的证据，以及三者融合的证据。进行统计分析以比较患侧和未患侧。
患侧大结节骨化核的出现明显延迟。患侧小结节骨化核的出现以及三者骨化核的融合有延迟趋势。与未患侧相比，患侧臂丛神经侧骨化持续的时间通常较短。
臂丛神经产瘫患侧存在骨化延迟，且骨化持续时间较短。
