Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Two Silverstein, Philadelphia, PA 19104, USA.
J Bone Joint Surg Am. 2010 Nov 3;92(15):2589-97. doi: 10.2106/JBJS.I.01390.
Patients with upper motor neuron injury can develop painful inferior glenohumeral subluxation with functional impairment. If the pain is relieved by manual reduction of the subluxation, this pain is considered mechanical in nature and potentially amenable to surgical treatment to maintain this reduction. The purpose of this study was to report our outcomes with use of the biceps suspension procedure to achieve shoulder joint reduction and pain relief in hemiplegic patients.
This retrospective case series of eleven consecutive hemiplegic patients with painful glenohumeral subluxation underwent surgical reduction with a biceps suspension procedure. Seven patients had, in addition, extra-articular tenotomies to treat coexisting muscular contractures. Pain, physical examination findings, and radiographs were evaluated before and after surgery. Patient satisfaction with the outcome of the surgery was determined as well.
The mean duration of the patient follow-up was 3.2 years (range, 2.0 to 5.8 years). The average patient age was 46.9 years (range, eighteen to eighty-one years). Ten of the patients were female. All patients had pain with passive shoulder motion preoperatively, but only one patient had such pain postoperatively (p < 0.001). At the time of follow-up after the surgery, the mean score for pain on a visual analog scale was 1.45 (range, 0 to 5), with all patients noting a decrease in pain. Ten patients noted that deformity was also decreased at the time of follow-up. All patients had a sulcus sign on physical examination preoperatively, but only three had such a sign postoperatively (p < 0.001). The seven patients who had undergone shoulder tenotomies had significant improvements in shoulder extension (p = 0.009), forward elevation (p = 0.030), abduction (p = 0.040), and external rotation (p = 0.043) postoperatively. Ten patients were satisfied with the outcome of the surgery. Preoperative radiographs demonstrated inferior subluxation of the humeral head at the glenohumeral joint in all patients. Postoperatively, ten patients had an improved glenohumeral joint position, and nine of these patients had complete reduction of the humeral head.
Biceps suspension surgery can provide pain relief in hemiplegic patients with painful subluxation of the humeral head after upper motor neuron injury. Tenotomy of contracted muscles around the shoulder can improve passive shoulder motion in patients with spastic hemiplegia. Following surgery, there were high rates of glenohumeral reduction and patient satisfaction.
上运动神经元损伤的患者可能会出现疼痛性肩胛盂下脱位，导致功能障碍。如果通过手动复位减轻了脱位引起的疼痛，那么这种疼痛被认为是机械性的，可能需要手术治疗来维持复位。本研究的目的是报告使用肱二头肌悬吊术治疗偏瘫患者肩关节复位和缓解疼痛的结果。
本回顾性连续病例系列研究纳入了 11 例患有疼痛性肩盂下脱位的偏瘫患者，均接受了肱二头肌悬吊术进行手术复位。7 例患者还进行了关节外肌腱切断术以治疗并存的肌肉挛缩。术前和术后评估疼痛、体格检查结果和影像学表现。还确定了患者对手术结果的满意度。
患者的平均随访时间为 3.2 年（范围，2.0 至 5.8 年）。平均患者年龄为 46.9 岁（范围，18 岁至 81 岁）。10 例患者为女性。所有患者术前均有被动肩部运动时疼痛，但只有 1 例患者术后有这种疼痛（p＜0.001）。在手术后的随访时，视觉模拟评分法的平均疼痛评分为 1.45（范围，0 至 5），所有患者均表示疼痛减轻。10 例患者还表示，在随访时畸形也有所改善。所有患者术前体格检查均有肩槽征，但只有 3 例术后有这种征（p＜0.001）。接受肩部肌腱切断术的 7 例患者术后肩关节伸展（p=0.009）、前举（p=0.030）、外展（p=0.040）和外旋（p=0.043）均有显著改善。10 例患者对手术结果满意。术前影像学检查显示所有患者盂肱关节处肱骨头有下脱位。术后，10 例患者盂肱关节位置得到改善，其中 9 例患者肱骨头完全复位。
肱二头肌悬吊术可缓解上运动神经元损伤后疼痛性肱骨头脱位的偏瘫患者的疼痛。肩部痉挛性偏瘫患者的肌肉挛缩肌腱切断术可改善被动肩部运动。手术后，盂肱关节复位率和患者满意度均较高。
