Musculoskeletal Plastic and Reconstructive Surgery Department, Emile-Gallé Surgical Center, Nancy, France.
Orthop Traumatol Surg Res. 2012 Oct;98(6):638-44. doi: 10.1016/j.otsr.2012.06.013. Epub 2012 Sep 14.
Children affected by obstetric brachial plexus palsy have an internal rotation contracture of the shoulder and a deformed glenohumeral joint. In 2003, Pearl proposed doing an arthroscopic release of the shoulder to restore external rotation and allow the glenohumeral joint to remodel. The goal of the current study was to evaluate the active and passive shoulder external rotation range of motion and glenohumeral joint remodelling in children treated with arthroscopic-directed release.
Between 2004 and 2010, 18 children with passive external rotation under 10° were treated with shoulder arthroscopy to release the anterior capsule and ligaments and perform a subscapularis tenotomy; no tendon transfer was performed. The average age was 4 years, 2 months. Nine children had an injury at C5C6, four had an injury at C5C6C7 and five had a complete injury. The average follow-up was 4.5 years. The clinical evaluation consisted of active and passive external rotation (ER) with elbow at the side, active internal rotation, and the modified Mallet score. One child who required an external rotation osteotomy of the proximal humerus was excluded from the clinical outcomes. An MRI was performed on both shoulders to assess glenoid retroversion, glenoid type, degree of posterior subluxation (measured by the percentage of humeral head anterior to the middle glenoid fossa) and humeral head hypoplasia.
At the latest follow-up, passive ER was 58° on average and active ER was 42°. Eleven children had regained more than 30° of active ER. The average internal rotation had decreased after the release. The MRI assessment showed that the glenohumeral joint had remodelled in 66% of cases; the glenoid type had improved, the glenoid retroversion had diminished and the humeral head was recentred. Humeral head hypoplasia was found in 28% of cases.
Arthroscopic release of the shoulder results in more external rotation and allows for glenohumeral joint remodelling. Tendon transfer is not always necessary to restore active external rotation.
Level IV - Retrospective study.
患有产伤性臂丛神经麻痹的儿童会出现肩部内旋挛缩和盂肱关节畸形。2003 年，Pearl 提出进行肩关节镜下松解术以恢复外旋并使盂肱关节重塑。本研究的目的是评估接受关节镜引导下松解术治疗的儿童的主动和被动肩关节外旋活动范围以及盂肱关节重塑情况。
2004 年至 2010 年间，18 例被动外旋小于 10°的儿童接受了肩关节镜下松解术，松解前囊和韧带，并进行肩胛下肌肌腱切断术；未进行肌腱转位。平均年龄为 4 岁 2 个月。9 例损伤在 C5C6，4 例损伤在 C5C6C7，5 例完全损伤。平均随访时间为 4.5 年。临床评估包括肘部位于体侧时的主动和被动外旋（ER）、主动内旋以及改良 Mallet 评分。1 例需要进行肱骨近端外旋截骨术的患儿被排除在临床结果之外。对双侧肩关节进行 MRI 检查，以评估盂肱关节后倾、盂肱关节类型、后脱位程度（通过肱骨头在前盂肱关节窝中的百分比测量）和肱骨头发育不良。
在最近的随访中，平均被动外旋为 58°，主动外旋为 42°。11 例患儿主动外旋恢复超过 30°。松解后，平均内旋减少。MRI 评估显示，66%的病例盂肱关节已重塑；盂肱关节类型改善，盂肱关节后倾减小，肱骨头居中。发现 28%的病例存在肱骨头发育不良。
肩关节镜下松解术可增加外旋，并使盂肱关节重塑。并非总是需要肌腱转位来恢复主动外旋。
IV 级-回顾性研究。
