Metsaars W P, Biegstraaten M, Nelissen R G H H
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
J Hand Microsurg. 2017 Apr;9(1):1-5. doi: 10.1055/s-0037-1598088. Epub 2017 Feb 7.
Retrospective cohort study. Supination deformity in obstetric brachial plexus injury can have debilitating consequences for the functionality of the hand. Surgical treatment by a forearm osteotomy has a recurrence rate of 20 to 42%. As a complement to forearm osteotomy, a biceps rerouting may improve outcome. Children with residual brachial plexus injury, who had a forearm osteotomy for a supination contracture and had a postoperative decrease of pronation to 50 degrees or less, were indicated for a biceps rerouting. Shoulder, elbow and hand function, biceps strength, Mallet score, and Raimondi score were assessed with a minimum follow-up of 2 years. Five patients (median age: 8 years; range: 4-10) underwent biceps rerouting between 2008 and 2012. Median follow-up time was 6.8 years (range: 3.2-7.0 years). Passive pronation increased in all cases (median 0 degree at baseline to 80 degrees at final follow-up). Active pronation also increased. Active median wrist extension was -30 degrees at baseline and 45 degrees at follow-up. Biceps strength and grip strength improved in two cases. No recurrences were present. The sequentially planned surgical treatment of forearm osteotomy and biceps rerouting should be considered in the treatment of severe supination deformity, as it is effective in improving pronation of the forearm and hand function, without recurrence at follow-up. Level III, case series, therapeutic study.
回顾性队列研究。产科臂丛神经损伤中的旋后畸形可对手部功能产生严重后果。前臂截骨术的手术治疗复发率为20%至42%。作为前臂截骨术的补充，肱二头肌改道术可能会改善治疗效果。对于因旋后挛缩接受前臂截骨术且术后旋前角度降至50度或更小的残留臂丛神经损伤儿童，建议进行肱二头肌改道术。对肩部、肘部和手部功能、肱二头肌力量、槌状指评分和雷蒙迪评分进行评估，最短随访时间为2年。2008年至2012年期间，5例患者（中位年龄：8岁；范围：4 - 10岁）接受了肱二头肌改道术。中位随访时间为6.8年（范围：3.2 - 7.0年）。所有病例的被动旋前均增加（基线时中位角度为0度，最终随访时为80度）。主动旋前也增加。主动中位腕关节伸展度基线时为 - 30度，随访时为45度。2例患者的肱二头肌力量和握力有所改善。无复发情况。对于严重旋后畸形的治疗，应考虑依次进行前臂截骨术和肱二头肌改道术的计划性手术治疗，因为它能有效改善前臂旋前和手部功能，随访时无复发。三级，病例系列，治疗性研究。
