Ahmad Alaaeldin Azmi
Department of Orthopedic, Alnajah Medical School , Nables Speciality Hospital, Nables Arab Care Hospital, Ramallah, The West Bank, Palestine.
J Pediatr Orthop. 2010 Sep;30(6):575-81. doi: 10.1097/BPO.0b013e3181e4f5a6.
Although the Sprengel deformity is relatively uncommon, several surgical procedures have been described for its treatment. In this article, we will report the outcome of a certain surgical technique targeted at the management of children with severe Sprengel deformity. The technique aims to increase their postoperative range of shoulder abduction.
We reviewed the results of 15 shoulders operated in 11 patients. The children had severe congenital elevated scapula (9 Cavendish IV and 6 Cavendish III) and were all with less than 90 degrees of preoperative shoulder abduction. The mean age at surgery was 64 months, the mean length of follow-up was 36.5 months, and the mean age at the last examination was 95 months. Surgery included fixation of the upper scapula to the lower thoracic spine. As such, we used a stout suture with lateral displacement of the inferior tip of the scapula and immediate postoperative mobilization with physiotherapy. None of the children underwent clavicular osteotomy. Operative results were evaluated on both functional and cosmetic bases.
Appearance improved according to the Cavendish scale. Postoperatively, 7 shoulders were graded as Cavendish I and the other 8 as Cavendish II. The range of motion improved significantly by comparing the preoperative and postoperative range of abduction. The mean for postoperative abduction was 139 degrees, with an absolute range of 90 to 170 degrees. Three shoulders had winging of the scapula. There was temporary postoperative upper arm numbness in 1 shoulder. Four patients had a cosmetically unattractive scar because of keloid formation. All families were satisfied with the results (9 very good and 6 good).
We have described a procedure for severe Sprengel deformity up to 15 years of age followed by immediate physiotherapy. This procedure not only results in the caudal displacement of the scapula, but it also corrects the scapular and glenoid plane (with limited procedures). Accordingly, it offers an improvement, both functionally and cosmetically.
Level IV therapeutic study.
尽管先天性高肩胛症相对少见，但已有多种手术方法用于治疗该疾病。在本文中，我们将报告一种针对重度先天性高肩胛症患儿的手术技术的治疗效果。该技术旨在增加患儿术后的肩关节外展范围。
我们回顾了11例患者15个肩关节的手术结果。这些患儿均患有严重的先天性高肩胛症（9例为卡文迪什IV型，6例为卡文迪什III型），术前肩关节外展均小于90度。手术平均年龄为64个月，平均随访时间为36.5个月，最后一次检查时的平均年龄为95个月。手术包括将肩胛骨上部固定于下胸椎。具体操作是使用一根粗缝线将肩胛骨下角向外侧移位，并在术后立即进行物理治疗以促进活动。所有患儿均未行锁骨截骨术。从功能和美观两方面对手术效果进行评估。
根据卡文迪什分级标准，外观得到改善。术后，7个肩关节评为卡文迪什I级，另外8个评为卡文迪什II级。通过比较术前和术后的外展范围，活动度有显著改善。术后外展的平均角度为139度，绝对范围为90至170度。3个肩关节出现肩胛骨翼状畸形。1个肩关节术后出现暂时性上臂麻木。4例患者因瘢痕疙瘩形成导致外观上有不美观的瘢痕。所有家庭对结果均满意（9例非常满意，6例满意）。
我们描述了一种针对15岁以下重度先天性高肩胛症的手术方法，并在术后立即进行物理治疗。该手术不仅能使肩胛骨向下移位，还能（通过有限的手术操作）纠正肩胛骨和关节盂平面。因此，在功能和美观方面均有改善。
IV级治疗性研究。
