García-López Antonio, Sebastian Pablo, Martinez-López Francisco
Upper Limb Unit, Orthopaedic Department, Hospital General Universitario de Alicante, Alicante, Spain.
J Hand Surg Am. 2012 Aug;37(8):1660-4. doi: 10.1016/j.jhsa.2012.05.002. Epub 2012 Jun 30.
A flexion contracture of the elbow is common in upper obstetric brachial plexus palsy. One less than 30° involves no major aesthetic or functional abnormalities, whereas for one greater than 30°, conservative treatment with serial splints produces variable results. We evaluated anterior release of the elbow with partial tenotomy of the anterior brachialis muscle and of the biceps, for their effect on elbow flexion contractures.
We performed 10 anterior releases of the elbow with lengthening of the distal tendons of the biceps and the anterior brachialis muscle. All patients had upper obstetric brachial plexus palsies (C5-C6) and elbow flexion contractures of 35° or greater (range, 35° to 60°). The flexion strength of the elbow was 4 or higher on the British Medical Research Council scale, and the patients had no bone abnormalities in the elbow region.
After a mean follow-up period of 3 years, the mean gain in extension was 28° (range, 20° to 35°). All patients maintained flexion strength. Elbow extension was 2° less than obtained at surgery and was maintained during follow-up. All patients were satisfied or very satisfied, and none presented major complications, except hypertrophic scarring to a greater or lesser extent at the incision site.
Anterior release of the elbow is a useful method for treating elbow flexion contractures of more than 35° and can reduce the deformity to bring it within functional range without compromising flexion.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
肘关节屈曲挛缩在上臂产瘫中很常见。小于30°的挛缩不涉及严重的美学或功能异常，而大于30°的挛缩，采用系列夹板保守治疗效果不一。我们评估了通过部分肱肌和肱二头肌肌腱切断术进行肘关节前路松解术对肘关节屈曲挛缩的影响。
我们对10例患者进行了肘关节前路松解术，并延长了肱二头肌和肱肌的远端肌腱。所有患者均患有上臂产瘫（C5-C6）且肘关节屈曲挛缩35°或更大（范围为35°至60°）。根据英国医学研究委员会的评分标准，肘关节的屈曲力量为4级或更高，且患者肘关节区域无骨骼异常。
平均随访3年后，平均伸直增加28°（范围为20°至35°）。所有患者均保持屈曲力量。肘关节伸直角度比手术时减少2°，且在随访期间保持不变。所有患者均满意或非常满意，除切口部位有不同程度的增生性瘢痕外，均未出现重大并发症。
肘关节前路松解术是治疗超过35°肘关节屈曲挛缩的有效方法，可减少畸形，使其恢复到功能范围内，同时不影响屈曲功能。
研究类型/证据水平：治疗性IV级。
