Kozin Scott H, Chafetz Ross S, Shaffer Alyssa, Soldado Francisco, Filipone Linda
Department of Orthopaedic Surgery, Temple University, Shriners Hospital for Children, Philadelphia, PA 19140, USA.
J Pediatr Orthop. 2010 Mar;30(2):154-60. doi: 10.1097/BPO.0b013e3181cfce09.
Incomplete recovery after brachial plexus birth palsy often results in decreased movement and muscle imbalance about the shoulder, as rotator cuff and deltoid innervation are incomplete. Tendon transfers redistribute the forces about the joint and were thought to promote glenohumeral joint remodeling. Early reports, however, indicate limited ability to affect joint configuration. Our previous report and conclusions to this regard were based upon short follow-up. The purpose of this study was to assess the magnetic resonance imaging and clinical outcome after tendon transfers about the shoulder in children with residual brachial plexus birth palsy.
This was a retrospective chart review of 24 children who underwent transfer of the latissimus dorsi and teres major to the posterior rotator cuff with or without concomitant musculotendinous lengthenings. Follow-up magnetic resonance imaging data were available for all subjects at 1-year postsurgery and 19 subjects at 3-year follow-up.
Preoperative average glenoid version was -25+/-13 degrees (range, -51- -11 degrees). Compared with preoperative version, there was no statistical difference at 1 year (-25+/-14 degrees; range, -56- -7 degrees; P=1.00) or at 3 years (-22+/-11 degrees; range, -54- -8 degrees; P=1.00). Preoperative average percent of humeral head anterior was 29%+/-15% (range, 0%-44%). Compared with preoperative percent of humeral head anterior, there was no statistical difference at 1 year (28%+/-16%; range, 0%-52%; P=1.00) or at 3 years (35%+/-13%; range, 0%-51%; P=0.32). Clinical evaluation showed significant improvements (P<0.05) in preoperative (-3+/-21) to 1-year (18+/-32) external rotation Significant improvements in abduction were found from 116+/-39 degrees before surgery to 151+/-30 degrees and 161+/-20 degrees at 1 and 3 years after surgery, respectively.
These results demonstrate that tendon transfers improve overall shoulder motion, but do not reduce humeral head subluxation or improve glenohumeral joint realignment.
Level IV.
臂丛神经产瘫后恢复不完全常导致肩部活动减少和肌肉失衡，因为肩袖和三角肌的神经支配不完全。肌腱转移可重新分配关节周围的力量，曾被认为可促进盂肱关节重塑。然而，早期报告显示其影响关节形态的能力有限。我们之前关于这方面的报告和结论是基于短期随访得出的。本研究的目的是评估残留臂丛神经产瘫患儿肩部肌腱转移后的磁共振成像和临床结果。
这是一项对24例接受背阔肌和大圆肌转移至肩袖后部伴或不伴肌肉肌腱延长术的儿童进行的回顾性病历审查。所有受试者术后1年均有随访磁共振成像数据，19例受试者有3年随访数据。
术前平均肩胛盂倾斜度为-25±13度（范围为-51至-11度）。与术前倾斜度相比，1年时（-25±14度；范围为-56至-7度；P = 1.00）和3年时（-22±11度；范围为-54至-8度；P = 1.00）均无统计学差异。术前肱骨头前倾角平均百分比为29%±15%（范围为0%至44%）。与术前肱骨头前倾角百分比相比，1年时（28%±16%；范围为0%至52%；P = 1.00）和3年时（35%±13%；范围为0%至51%；P = 0.32）均无统计学差异。临床评估显示，术前（-3±21）至1年时（18±32）的外旋有显著改善（P<0.05）。外展方面，术前116±39度分别显著改善至术后1年的151±30度和术后3年的161±20度。
这些结果表明，肌腱转移可改善肩部整体活动，但不能减少肱骨头半脱位或改善盂肱关节复位。
四级。
