Reading Shoulder Unit, Royal Berkshire Hospital, London Road, Reading, Berkshire RG1 5AN, UK.
J Bone Joint Surg Am. 2013 Aug 7;95(15):1404-8. doi: 10.2106/JBJS.L.01097.
Shoulder girdle muscle weakness is the most constant feature of facioscapulohumeral muscular dystrophy and leads to scapular winging. Mechanical fixation of the scapula to the thoracic wall provides a stable fulcrum on which the deltoid muscle can exert its action on the humerus. The aim of this study was to evaluate the medium to long-term outcome of thoracoscapular arthrodesis with screw fixation (the modified Howard-Copeland technique).
All patients with facioscapulohumeral dystrophy who underwent thoracoscapular arthrodesis with screw fixation and bone-grafting from July 1997 to July 2010 were retrospectively reviewed. Preoperative and postoperative clinical assessment included active shoulder elevation, the Constant score, a patient satisfaction score, and cosmetic satisfaction. Union was determined both clinically and radiographically.
Thoracoscapular arthrodesis was performed in thirty-five shoulders in twenty-four patients; eleven patients underwent bilateral procedures. The principal study group consisted of thirty-two shoulders in twenty-one patients with a minimum follow-up of twenty-four months (mean, eighty-eight months; range, twenty-four to 174 months). The mean Constant score increased from 30 (range, 17 to 41) preoperatively to 61 (range, 30 to 90) postoperatively. The mean satisfaction score increased from 1 (range, 0 to 4) to 8.4 (range, 4 to 10). Early complications consisted of one pneumothorax, one superficial wound infection, and four early failures, two of which were associated with noncompliance with the postoperative regimen. Late complications consisted of one posttraumatic fracture resulting in loosening and one painful nonunion; both were treated successfully with revision.
Thoracoscapular arthrodesis with screw fixation prevented scapular winging and improved short-term and long-term shoulder function in patients with facioscapulohumeral dystrophy.
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
肩胛带肌无力是面肩肱型肌营养不良症最常见的特征，导致肩胛骨翼状突出。肩胛骨机械性固定于胸壁为三角肌在肱骨上施加作用提供了一个稳定的支点。本研究的目的是评估采用螺钉固定（改良 Howard-Copeland 技术）行肩胛胸壁融合术的中远期疗效。
回顾性分析 1997 年 7 月至 2010 年 7 月采用螺钉固定和植骨行肩胛胸壁融合术的所有面肩肱型肌营养不良症患者。术前和术后临床评估包括主动肩抬高、Constant 评分、患者满意度评分和美容满意度。通过临床和影像学检查来确定融合情况。
24 例患者的 35 侧肩部行肩胛胸壁融合术，其中 11 例患者行双侧手术。主要研究组由 21 例患者的 32 侧肩部组成，随访时间至少 24 个月（平均 88 个月；范围 24 至 174 个月）。术前 Constant 评分为 30 分（范围 17 至 41 分），术后为 61 分（范围 30 至 90 分），评分均显著提高。术前满意度评分为 1 分（范围 0 至 4 分），术后为 8.4 分（范围 4 至 10 分），评分均显著提高。早期并发症包括气胸 1 例、浅表伤口感染 1 例和早期失败 4 例，其中 2 例与术后不遵医嘱有关。晚期并发症包括创伤后骨折导致松动和 1 例疼痛性不愈合，均经翻修成功治疗。
采用螺钉固定行肩胛胸壁融合术防止了肩胛骨翼状突出，并改善了面肩肱型肌营养不良症患者的短期和长期肩部功能。
治疗性 IV 级。欲了解完整的证据等级说明，请参见作者须知。
