Sibiński Marcin, Bara Tomasz, Adamczyk Emil, Synder Marek
Klinika Ortopedii i Ortopedii Dzieciecej Uniwersytetu Medycznego w Łodzi.
Chir Narzadow Ruchu Ortop Pol. 2010 Jan-Feb;75(1):5-9.
The purpose of the study was to analyze shoulder, elbow and forearm function in children with persistent obstetric brachial plexus palsy. We aimed also to evaluate relationship between age, severity of root involvement and functional deficit of affected limb.
Fifty-one patients with the Mallet score less than 23 points were entered into a prospective study. Their average age was 6 years and 6 months (range from 18 months to 19 years). There were 30 boys and 21 girls. Clinical data from last follow-up was evaluated.
Average Mallet score was 17 points at last follow-up. The most common problem found in 60% of children was limitation of active external rotation of the shoulder. One forth of patients had posterior dislocation or subluxation in glenohumeraljoint. Moreover, 35.3% had significant limitation of active flexion, 37.3% had limitation of active abduction and 37.3% had limitation of internal rotation of shoulder. Limitation of active forearm pronation was found in 37% and active supination in 50% of patients. Persistent limb dysfunction (except shoulder external rotation) was dependent on root involvement but did not depend on patient's age.
Limitation of shoulder external rotation with concomitant posterior subluxation or dislocation of the glenohumeral joint is the most common finding in patients with obstetric brachial plexus palsy and does not depend on severity of root involvement, as is related to suprascapular nerve injury. The other shoulder movement are more effected in children with more severe nerve root involvement. Half of our patients had had limitation of forearm supination, what may be related to more common use of pronation in everyday activities.
本研究旨在分析持续性产瘫性臂丛神经麻痹患儿的肩部、肘部和前臂功能。我们还旨在评估年龄、神经根受累严重程度与患侧肢体功能缺陷之间的关系。
51例槌状指评分低于23分的患者纳入前瞻性研究。他们的平均年龄为6岁6个月（范围从18个月至19岁）。其中男孩30例，女孩21例。评估了上次随访的临床数据。
上次随访时槌状指平均评分为17分。60%的儿童中最常见的问题是肩部主动外旋受限。四分之一的患者存在盂肱关节后脱位或半脱位。此外，35.3%的患者主动屈曲明显受限，37.3%的患者主动外展受限，37.3%的患者肩部内旋受限。37%的患者存在主动前臂旋前受限，50%的患者存在主动旋后受限。持续性肢体功能障碍（肩部外旋除外）取决于神经根受累情况，但不取决于患者年龄。
产科臂丛神经麻痹患者中最常见的表现是肩部外旋受限并伴有盂肱关节后半脱位或脱位，且不取决于神经根受累的严重程度，这与肩胛上神经损伤有关。神经根受累更严重的儿童，其他肩部运动受影响更大。我们一半的患者存在前臂旋后受限，这可能与日常活动中更常使用旋前有关。
