Metsaars Wieneke P, Henseler Jan Ferdinand, Nagels Jochem, Nelissen Rob G
Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands.
Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands.
J Hand Surg Am. 2017 Nov;42(11):925.e1-925.e11. doi: 10.1016/j.jhsa.2017.06.002. Epub 2017 Aug 30.
Forearm osteotomy for supination deformity in brachial plexus birth palsy (BPBP) may lead to improved function of the upper limb. However, recurrence rates are high and limit satisfactory results.
We reviewed the long-term outcome of the entire upper limb of 22 BPBP patients with a supination contracture who were treated by forearm osteotomy and compared them with an age-matched group that was treated nonsurgically (n = 28). Recurrence was defined as a passive pronation below 30°.
The median follow-up was 5.0 years (range, 1.5-14 years). The mean passive pronation after forearm osteotomy, including patients with recurrence at follow-up, improved from -1° (SD, 9°) to 33° (SD, 48°) at final follow-up, mean active wrist extension improved from 23° (SD, 40°) to 41° (SD, 38°). An overall improvement of wrist and hand strength was present. In patients without recurrence, pronation improved to a mean of 66° (SD, 23°) at final follow-up. Recurrence of the supination contracture was present in 9 cases (41%) and was only present in patients with a single bone osteotomy. Recurrence was associated with lower age at surgery (recurrence mean, 4 [SD, 1.2] and no recurrence 8 [SD 4.5]), lower shoulder external rotation (recurrence mean, 28 [SD, 17] and no recurrence 49 [SD, 23]), and overall lower hand function at baseline.
Forearm osteotomy improves forearm pronation and hand function. Recurrence should be considered as a potential complication after forearm osteotomy and is associated with young age and lower function of shoulder and hand. Single-bone osteotomy might also be a risk factor for recurrence.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
臂丛神经产瘫（BPBP）中，为矫正旋后畸形进行的前臂截骨术可能会改善上肢功能。然而，复发率很高，限制了理想的治疗效果。
我们回顾了22例因旋后挛缩接受前臂截骨术治疗的BPBP患者整个上肢的长期预后，并将其与年龄匹配的非手术治疗组（n = 28）进行比较。复发定义为被动旋前角度低于30°。
中位随访时间为5.0年（范围1.5 - 14年）。前臂截骨术后，包括随访时复发的患者，末次随访时平均被动旋前角度从-1°（标准差9°）改善至33°（标准差48°），平均主动腕背伸角度从23°（标准差40°）改善至41°（标准差38°）。腕部和手部力量总体有所改善。在无复发的患者中，末次随访时旋前角度平均改善至66°（标准差23°）。9例（41%）出现旋后挛缩复发，且仅见于单骨截骨的患者。复发与手术时年龄较小（复发组平均年龄4岁[标准差1.2]，无复发组8岁[标准差4.5]）、肩部外旋角度较小（复发组平均28°[标准差17°]，无复发组49°[标准差23°]）以及基线时总体手部功能较差有关。
前臂截骨术可改善前臂旋前和手部功能。应将复发视为前臂截骨术后的一种潜在并发症，且与年龄小、肩部和手部功能较低有关。单骨截骨术也可能是复发的一个危险因素。
研究类型/证据水平：治疗性IV级。
