Gong Hyun Sik, Cho Hoyune Esther, Chung Chin Youb, Park Moon Seok, Lee Hyuk Jin, Baek Goo Hyun
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; Albert Einstein College of Medicine, Bronx, NY; Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea; Albert Einstein College of Medicine, Bronx, NY; Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
J Hand Surg Am. 2014 May;39(5):902-9. doi: 10.1016/j.jhsa.2014.02.012. Epub 2014 Mar 25.
To investigate the effect of partial biceps lengthening on elbow flexion posture and active elbow flexion and extension in patients with cerebral palsy.
We retrospectively reviewed 29 patients with cerebral palsy who underwent anterior elbow release as part of multilevel upper extremity surgery. The early series of the patients (N = 14; group 1) had lacertus fibrosus division, brachialis fractional lengthening, and denuding of the pretendinous adventitia off the biceps tendon. The later series of patients (N = 15; group 2) had partial biceps tendon lengthening in addition to the procedures in group 1. We compared the 2 sets of patients for elbow flexion posture, active elbow flexion and extension, forearm rotation, and House scores, with mean follow-ups of 72 months for group 1 and 31 months for group 2.
The 2 groups were comparable in terms of mean age, number of procedures, and preoperative House scores. Group 2 patients had more improvement in flexion posture (53° vs. 44°) and active extension (23° vs. 15°) than group 1 postoperatively. However, group 2 had a mean decrease of 7° in active elbow flexion, whereas group 1 had no changes. There was no difference in forearm supination or in the improvement of House scores between groups.
Early results of partial lengthening of the biceps tendon showed that it may improve elbow flexion posture and active elbow extension in patients with flexion deformity in cerebral palsy.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
探讨部分肱二头肌延长术对脑瘫患者肘关节屈曲姿势及主动屈伸功能的影响。
我们回顾性分析了29例行前路肘关节松解术的脑瘫患者，该手术是多级上肢手术的一部分。早期的一组患者（n = 14；第1组）进行了肱桡肌切断、肱肌部分延长以及肱二头肌腱腱膜剥离。后期的一组患者（n = 15；第2组）除了进行第1组的手术外，还进行了部分肱二头肌肌腱延长术。我们比较了两组患者的肘关节屈曲姿势、主动屈伸功能、前臂旋转功能及豪斯评分，第1组平均随访72个月，第2组平均随访31个月。
两组患者在平均年龄、手术次数及术前豪斯评分方面具有可比性。术后第2组患者在屈曲姿势（53°对44°）和主动伸展（23°对15°）方面的改善比第1组更多。然而，第2组患者的主动肘关节屈曲平均下降了7°，而第1组无变化。两组在前臂旋后或豪斯评分改善方面无差异。
肱二头肌肌腱部分延长术的早期结果表明，该手术可能改善脑瘫患者屈曲畸形时的肘关节屈曲姿势及主动伸展功能。
研究类型/证据水平：治疗性III级。
