Acan Ahmet Emrah, Gursan Onur, Demirkiran Nihat Demirhan, Havitcioglu Hasan
Dokuz Eylül University, İzmir, Turkey.
Dokuz Eylül University Hospital, Turkey.
Acta Orthop Traumatol Turc. 2018 Jan;52(1):75-80. doi: 10.1016/j.aott.2017.03.019. Epub 2017 May 8.
To date, all the authors who have recommended external rotation osteotomy (ERO) in the late treatment of obstetrical brachial plexus palsy (OBPP), have neglected upper limb length discrepancy, which is an another sequelae of OBPP. In this paper, a new technique is reported for the late treatment of OBPP patients with upper limb length discrepancy, in which both humeral external rotation osteotomy (ERO) and lengthening are applied with an intramedullary elongation nail. With this technique, upper limb function is improved through re-orientation of the shoulder arc to a more functional range, and further improvements will be seen in the appearance of the upper limb with the elimination of length discrepancy. It is also advocated that there is a potentiating effect of the humeral lengthening on shoulder movements gained by ERO when the osteotomy is applied above the deltoid insertion, as this allows more lateralized placement of the deltoid insertion.
迄今为止，所有推荐在产科臂丛神经麻痹（OBPP）晚期治疗中采用外旋截骨术（ERO）的作者，都忽略了上肢长度差异，这是OBPP的另一种后遗症。本文报道了一种治疗伴有上肢长度差异的OBPP患者晚期的新技术，该技术采用髓内延长钉同时进行肱骨外旋截骨术（ERO）和延长术。通过将肩弧重新定向到更具功能的范围，上肢功能得以改善，并且随着长度差异的消除，上肢外观也将得到进一步改善。还提倡当截骨术应用于三角肌止点上方时，肱骨延长对ERO获得的肩部运动有增强作用，因为这允许三角肌止点更偏向外侧放置。
