Nath Rahul K, Somasundaram Chandra
Texas Nerve and Paralysis Institute, Houston.
Eplasty. 2012;12:e54. Epub 2012 Dec 4.
To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy.
We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5-9 years) with obstetric brachial plexus injury.
We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1-17.9 years).
The mean preoperative total Mallet score was 14.8 (range, 10-20), and active abduction was 84° (range, 20°-140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13-25, P < .0001), and the mean active abduction improved to 132° (range, 40°-180°, P < .0003).
The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder.
评估改良Quad手术治疗儿童及青少年臂丛神经产瘫的疗效。
我们之前已经证明，改良Quad手术可使患有产科臂丛神经损伤的儿童（平均年龄2.5岁；范围0.5 - 9岁）的肩部外展功能得到显著改善。
我们在本报告中描述了16例患者（6名女孩和10名男孩；7名儿童和9名青少年）接受改良Quad手术以纠正肩部功能，特别是外展功能的结果。患者接受了背阔肌和大圆肌转移、肩胛下肌、胸大肌和胸小肌挛缩松解以及腋神经减压和神经松解（改良Quad手术）。这些患者手术时的平均年龄为13.5岁（范围10.1 - 17.9岁）。
术前平均Mallet总评分为14.8（范围10 - 20），主动外展角度为84°（范围20° - 140°）。平均随访1.5年后，术后平均Mallet总评分增至19.7（范围13 - 25，P < .0001），平均主动外展角度改善至132°（范围40° - 180°，P < .0003）。
改良Quad手术不仅能显著改善儿童及青少年患者的主动外展功能，还能改善其他肩部功能，这一结果是腋神经减压和神经松解以及肩部内旋挛缩松解共同作用的结果。
