Jennings John D, Greenhill Dustin A, Kozin Scott H, Zlotolow Dan A
*Department of Orthopaedic Surgery & Sports Medicine, Temple University Hospital †Shriners Hospital for Children, Philadelphia, PA.
Tech Hand Up Extrem Surg. 2017 Jun;21(2):48-54. doi: 10.1097/BTH.0000000000000156.
Brachial plexus birth palsy resolves spontaneously in a majority of patients, however, others may have serious permanent dysfunction. Although nerve transfers or grafts are early options for treatment, many children have residual deficits or present too late for such procedures. In these patients, rotational osteotomy of the humerus may restore improved function and motion. Unfortunately, traditional humeral osteotomies only provide correction in a single plane, therefore appropriate correction of the typical residual deformity is incomplete. Here, we describe a novel technique for obtaining a calculated correction in 3 planes using a single osteotomy of the humerus on the basis of a mathematical equation. Nine patients are described here with an average of 35.4 months follow-up. Corrections were obtained in adduction, extension, and either internal or external rotation depending on the initial deformity and Modified Mallet scores were collected for each patient. There was 1 case of transient radial nerve palsy with no long-term complications overall.
大多数臂丛神经产瘫患者可自发恢复，但也有其他患者可能会出现严重的永久性功能障碍。尽管神经移位或移植是早期治疗选择，但许多儿童仍有残留缺陷或就诊过晚而无法进行此类手术。对于这些患者，肱骨旋转截骨术可恢复改善功能和活动。不幸的是，传统的肱骨截骨术仅能在单一平面进行矫正，因此对典型残留畸形的适当矫正并不完全。在此，我们描述一种基于数学方程通过单次肱骨截骨在三个平面获得计算矫正的新技术。本文描述了9例患者，平均随访35.4个月。根据初始畸形情况，在内收、伸展以及内旋或外旋方面均获得了矫正，并收集了每位患者的改良槌状指评分。总体上有1例出现短暂性桡神经麻痹，无长期并发症。
