Istanbul University, Istanbul Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Division of Hand Surgery, Capa, Istanbul.
BMC Musculoskelet Disord. 2011 Apr 13;12:74. doi: 10.1186/1471-2474-12-74.
The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not.
A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion.
In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles.
In this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.
产科臂丛神经麻痹的手术治疗一般可分为两组；早期重建，即处理臂丛或受累神经，以及晚期或姑息性重建，即处理残余畸形。肌腱转移是姑息性手术的主要方法。偶尔，外科医生需要利用已经去神经和随后再神经支配的肌肉作为动力。本研究旨在比较早期神经手术后接受肌腱转移治疗的患者与未接受神经手术的患者的残余肩部功能障碍的结果。
回顾性分析了 2002 年至 2009 年间，91 例因产科瘫痪导致肩外展和外旋功能障碍的患者接受改良 Hoffer 转移术，即背阔肌/大圆肌移至肱骨大结节的肌腱。将在婴儿期接受神经手术的患者与未接受神经手术的患者进行比较，比较他们术前和术后肩外展和外旋的主动活动范围。
在早期手术组中，只有术后外旋角度有统计学意义的差异（总麻痹和上部型麻痹的角度分别为 25 度和 75 度）。在单纯姑息手术组中，术前和术后外展和外旋角度均无显著差异。术前总麻痹的早期手术组和单纯姑息手术组之间的显著差异在术后减轻（分别为 p<0.05 和 p>0.05），但外旋角度无显著差异。在上部型麻痹组中，术前和术后外展和外旋角度无显著差异。
在这项研究中，我们发现对于完全麻痹的患者，无论是否有神经手术史，肌腱转移都可以获得满意的肩外展值，即使术前值不同。
