Bhardwaj Praveen, Burgess Tanya, Sabapathy S Raja, Venkataramani Hari, Ilayaraja Venkatachalam
Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, and Burns, Ganga Hospital, Coimbatore, India.
J Hand Surg Am. 2013 Aug;38(8):1557-66. doi: 10.1016/j.jhsa.2013.04.025. Epub 2013 Jun 28.
The shoulder is the most common site of secondary deformities after birth brachial plexus palsy. The severity and the pattern of deformity vary in patients and have implications for clinical decision making. This study aimed to find the correlation between clinical findings and computed tomography (CT) scan parameters for these deformities.
This prospective study included 75 patients aged 3 to 23 years. The clinical parameters included age, extent of involvement (nerve roots affected), degree of shoulder abduction, active and passive external rotation, and Mallet score. These were correlated with 3 CT scan parameters: elevation of the scapula above the clavicle, relative glenoid version, and percentage of the humeral head anterior to the scapular line.
There was a significant correlation between lack of active and passive external rotation and relative glenoid version and humeral head subluxation. There was a significant correlation between active abduction and elevation of the scapula above the clavicle. There was no significant correlation between age or Mallet score with any of the CT scan parameters.
These results suggest that presence of active and passive external rotation beyond 10° is associated with significantly lesser shoulder deformity irrespective of the degree of shoulder abduction. Hence, a patient with more than 10° external rotation does not need a screening CT scan evaluation regardless of the degree of shoulder abduction present. Conversely, a lack of external rotation beyond 10° strongly suggests relative glenoid retroversion and posterior subluxation of the humeral head and should be considered a clinical indicator of shoulder deformation.
TYPE STUDY/LEVEL OF EVIDENCE: Diagnostic II.
肩部是出生后臂丛神经麻痹后继发性畸形最常见的部位。畸形的严重程度和模式在患者中各不相同，对临床决策有影响。本研究旨在找出这些畸形的临床发现与计算机断层扫描（CT）扫描参数之间的相关性。
这项前瞻性研究纳入了75名年龄在3至23岁之间的患者。临床参数包括年龄、受累程度（受影响的神经根）、肩关节外展程度、主动和被动外旋以及马利特评分。将这些参数与3个CT扫描参数进行相关性分析：肩胛骨高于锁骨的高度、相对关节盂方向以及肱骨头位于肩胛线前方的百分比。
主动和被动外旋受限与相对关节盂方向及肱骨头半脱位之间存在显著相关性。主动外展与肩胛骨高于锁骨的高度之间存在显著相关性。年龄或马利特评分与任何CT扫描参数之间均无显著相关性。
这些结果表明，无论肩关节外展程度如何，主动和被动外旋超过10°与明显较轻的肩部畸形相关。因此，无论肩关节外展程度如何，外旋超过10°的患者无需进行筛查CT扫描评估。相反，外旋未超过10°强烈提示相对关节盂后倾和肱骨头后脱位，应被视为肩部变形的临床指标。
研究类型/证据水平：诊断性研究II级。
