Abdel-Ghani H, Hamdy K A, Basha N, Tarraf Y N
Paediatric Orthopaedic Unit, Faculty of Medicine, Cairo University, Cairo, Egypt.
J Hand Surg Eur Vol. 2012 Oct;37(8):781-6. doi: 10.1177/1753193412451401. Epub 2012 Jun 26.
We retrospectively analyzed 63 patients with internal rotation contracture of the shoulder secondary to brachial plexus birth palsy treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n = 18) or latissimus dorsi and teres major transfer (group B: n = 45) to the rotator cuff. The mean age at time of surgery was 43 months (SD 21 months; range 8 months to 9 years). We used a modification of the Gilbert shoulder grading system for assessment. All patients showed statistically significant improvement of active shoulder abduction and external rotation without significant differences between the two groups. Significant external rotation contracture of the shoulder (inability to touch the abdomen with the wrist extended) occurred in 42 of 63 patients, and there was a greater incidence of external rotation contracture in group B. We conclude that surgery should be restricted to latissimus dorsi transfer without teres major transfer to avoid external rotation contractures. Our modification of the Gilbert grading system appears to be valid and applicable.
我们回顾性分析了63例因臂丛神经产瘫继发肩内旋挛缩的患者，这些患者接受了肩胛下肌滑动联合背阔肌转移（A组：n = 18）或背阔肌和大圆肌转移（B组：n = 45）至肩袖的治疗。手术时的平均年龄为43个月（标准差21个月；范围8个月至9岁）。我们采用改良的吉尔伯特肩部评分系统进行评估。所有患者的主动肩外展和外旋均有统计学意义的改善，两组间无显著差异。63例患者中有42例出现明显的肩外旋挛缩（腕关节伸直时无法触及腹部），B组外旋挛缩的发生率更高。我们得出结论，手术应限于背阔肌转移而不进行大圆肌转移，以避免外旋挛缩。我们对吉尔伯特评分系统的改良似乎有效且适用。
