Ruchelsman David E, Ramos Lorna E, Price Andrew E, Grossman Leslie Agatha, Valencia Herbert, Grossman John A I
Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.
J Pediatr Orthop. 2011 Jun;31(4):455-7. doi: 10.1097/BPO.0b013e31821adcc0.
Children with brachial plexus birth injuries often require tendon transfer to restore active wrist extension and maximize hand function. The purpose of this study is to assess the clinical results in children with brachial plexus birth injuries after tendon transfer to reconstruct active wrist extension. Over a 10-year period, 21 children (11 male, 10 female) underwent tendon transfer to reconstruct active wrist extension by a single surgeon. Eight patients had C5/C6/C7 injury and 13 patients had global palsy (C5-T1). The average age at surgery was 5.5 years (range, 3 to 8 y). Restoration of wrist extension was measured according to the functional scale of Duclos and Gilbert. The mean duration of follow-up was 36 months (minimum follow-up of 1 y). At latest follow-up, 14 (66%) children (C5/C6/C7, n=8; global, n=6) demonstrated active wrist extension ≥ 30 degrees. Within the global injury subcohort, 3 patients demonstrated static extension of the wrist. Four failures occurred in the global palsy group. Children with absent active wrist extension after a brachial plexus birth injury can benefit from a tendon transfer. The more severe global palsy cases have a worse outcome.
臂丛神经产伤患儿常需进行肌腱转位以恢复主动腕背伸并最大化手部功能。本研究旨在评估臂丛神经产伤患儿在进行肌腱转位重建主动腕背伸后的临床效果。在10年期间，21例患儿（11例男性，10例女性）由同一位外科医生进行肌腱转位以重建主动腕背伸。8例患儿为C5/C6/C7损伤，13例患儿为全臂丛麻痹（C5-T1）。手术平均年龄为5.5岁（范围3至8岁）。根据Duclos和Gilbert功能量表评估腕背伸的恢复情况。平均随访时间为36个月（最短随访1年）。在最近一次随访时，14例（66%）患儿（C5/C6/C7损伤组8例，全臂丛麻痹组6例）主动腕背伸≥30度。在全臂丛麻痹亚组中，3例患儿表现为腕关节静力性背伸。全臂丛麻痹组出现4例失败病例。臂丛神经产伤后无主动腕背伸的患儿可从肌腱转位中获益。全臂丛麻痹越严重的病例预后越差。
