Seruya Mitchel, Johnson Joshua D
Division of Plastic and Maxillofacial Surgery, USC Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Semin Plast Surg. 2016 Feb;30(1):45-50. doi: 10.1055/s-0035-1571253.
The shoulder joint is essential for placing the hand in a functional position for reach and overhead activities. This depends on the delicate balance between abductor/adductor and internal/external rotator muscles. Spasticity alters this equilibrium, limiting the interaction of the upper limb with the environment. Classically, pediatric patients with upper limb spasticity present with an adduction and internal rotation contracture of the shoulder. These contractures are typically secondary to spasticity of the pectoralis major and subscapularis muscles and sometimes attributed to the latissimus dorsi muscle. Fractional lengthening, Z-step lengthening, or tendon release of the contributing muscle groups may help correct the adduction and internal rotation contractures. With proper diagnosis, a well-executed surgical plan, and a consistent hand rehabilitation regimen, successful surgical outcomes can be achieved.
肩关节对于将手放置在进行够物和过头活动的功能位置至关重要。这取决于外展肌/内收肌和内旋肌/外旋肌之间的微妙平衡。痉挛会改变这种平衡，限制上肢与环境的相互作用。典型的是，患有上肢痉挛的儿科患者会出现肩部内收和内旋挛缩。这些挛缩通常继发于胸大肌和肩胛下肌的痉挛，有时也归因于背阔肌。对相关肌肉群进行分次延长、Z形步延长或肌腱松解可能有助于纠正内收和内旋挛缩。通过正确的诊断、精心执行的手术计划和持续的手部康复方案，可以取得成功的手术效果。
