Carlson Michelle G, Hearns Krystle A, Inkellis Elizabeth, Leach Michelle E
Hospital for Special Surgery, New York, NY, USA.
J Hand Surg Am. 2012 Aug;37(8):1665-71. doi: 10.1016/j.jhsa.2012.05.013.
Elbow flexion posture, caused by spasticity of the muscles on the anterior surface of the elbow, is the most common elbow deformity seen in patients with cerebral palsy. This study retrospectively evaluated early results of 2 surgical interventions for elbow flexion deformities based on degree of contracture. We hypothesized that by guiding surgical treatment to degree of preoperative contracture, elbow extension and flexion posture angle at ambulation could be improved while preserving maximum flexion.
Eighty-six patients (90 elbows) were treated for elbow spasticity due to cerebral palsy. Seventy-one patients (74 elbows) were available for follow-up. Fifty-seven patients with fixed elbow contractures less than 45° were surgically treated with a partial elbow muscle lengthening, which included partial lengthening of the biceps and brachialis and proximal release of the brachioradialis. Fourteen patients (17 elbows) with fixed elbow contractures ≥ 45° had a more extensive full elbow release, with biceps z-lengthening, partial brachialis myotomy, and brachioradialis proximal release.
Age at surgery averaged 10 years (range, 3-20 y) for partial lengthening and 14 years (range, 5-20 y) for full elbow release. Follow-up averaged 22 months (range, 7-144 mo) for partial lengthening and 18 months (range, 6-51 mo) for full elbow release. Both groups achieved meaningful improvement in flexion posture angle at ambulation, active and passive extension, and total range of motion. Elbow flexion posture angle at ambulation improved by 57° and active extension increased 17° in the partial lengthening group, with a 4° loss of active flexion. In the full elbow release group, elbow flexion posture angle at ambulation improved 51° and active extension improved 38°, with a loss of 19° of active flexion.
Surgical treatment of spastic elbow flexion in cerebral palsy can improve deformity. We obtained excellent results by guiding the surgical intervention by the amount of preoperative elbow contracture.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
由肘部前侧肌肉痉挛引起的肘屈曲姿势是脑瘫患者中最常见的肘部畸形。本研究基于挛缩程度回顾性评估了两种针对肘屈曲畸形的手术干预的早期结果。我们假设，通过根据术前挛缩程度指导手术治疗，在保留最大屈曲度的同时，可改善步行时的肘伸展和屈曲姿势角度。
86例（90个肘部）因脑瘫导致肘痉挛的患者接受了治疗。71例（74个肘部）患者可供随访。57例固定肘挛缩小于45°的患者接受了部分肘肌延长手术治疗，包括肱二头肌和肱肌的部分延长以及桡侧腕长伸肌近端松解。14例（17个肘部）固定肘挛缩≥45°的患者进行了更广泛的全肘松解术，包括肱二头肌Z形延长、部分肱肌肌切开术和桡侧腕长伸肌近端松解。
部分延长术组手术时的平均年龄为10岁（范围3 - 20岁），全肘松解术组为14岁（范围5 - 20岁）。部分延长术组的平均随访时间为22个月（范围7 - 144个月），全肘松解术组为18个月（范围6 - 51个月）。两组在步行时的屈曲姿势角度、主动和被动伸展以及总活动范围方面均取得了有意义的改善。部分延长术组步行时的肘屈曲姿势角度改善了57°，主动伸展增加了17°，主动屈曲减少了4°。在全肘松解术组中，步行时的肘屈曲姿势角度改善了51°，主动伸展改善了38°，主动屈曲减少了19°。
脑瘫痉挛性肘屈曲的手术治疗可改善畸形。通过根据术前肘挛缩程度指导手术干预，我们取得了优异的结果。
研究类型/证据水平：治疗性IV级。
