van der Lingen M A J, de Joode S G C J, Schotanus M G M, Grimm B, van Nie F A, Speth L A W M, Samijo S K
Department of Orthopaedic Surgery and Traumatology, Maxima Medical Center, Veldhoven, The Netherlands.
Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands.
Eur J Orthop Surg Traumatol. 2018 Aug;28(6):1089-1094. doi: 10.1007/s00590-018-2152-8. Epub 2018 Feb 16.
Patients with an upper brachial plexus lesion can suffer from dysfunction, joint deformities and instability of the shoulder. The goal of this study was to determine pain, shoulder function, patient satisfaction and muscle strength in shoulder arthrodesis in patients with an upper brachial plexus lesion more than 15 years after surgery.
We retrospectively studied 12 patients with a brachial plexus lesion of mean age 46 years (27-61). At a mean of 19.8 years (15.4-30.3) after shoulder arthrodesis, patient-reported outcome measures (PROMs), range of motion (e.g., active and passive), patient satisfaction, strength of the affected and non-affected side (e.g., maximum isometric strength in Newton in forward and retroflexion, ab- and adduction, internal and external rotation) and position of fusion were obtained. PROMS consisted of the Visual Analogue Scale (VAS; 0-100, 0 being painless) for pain and the Disabilities of the Arm, Shoulder and Hand Score (DASH; 0-100, 0 being the best score) for function.
At latest follow-up, the median VAS pain score was 49 (0-96) and 0 for, respectively, the affected and unaffected side. The DASH was 15 (8-46), meaning a reasonable to good function of the upper extremity. Active and passive retroflexion was significantly different (p = 0.028). All subjects stated that in the same situation they would undergo a shoulder arthrodesis again. The unaffected side was significantly stronger in every direction. Arthrodesis showed position of fusion of 31° (12-70) abduction, 20° (10-50) forward flexion and 22° (- 14 to 58) internal rotation. The unaffected side was significantly (p ≤ 0.05) stronger in every movement direction.
At a mean of 20 years after shoulder arthrodesis, patients with an upper brachial plexus lesion are still satisfied with a good to moderate functional improvement.
A retrospective cohort study.
上臂丛神经损伤患者可能会出现功能障碍、关节畸形以及肩部不稳定。本研究的目的是确定上臂丛神经损伤患者术后超过15年进行肩关节融合术后的疼痛、肩部功能、患者满意度和肌肉力量。
我们回顾性研究了12例臂丛神经损伤患者，平均年龄46岁（27 - 61岁）。在肩关节融合术后平均19.8年（15.4 - 30.3年）时，获取患者报告的结局指标（PROMs）、活动范围（如主动和被动）、患者满意度、患侧和非患侧的力量（如前屈和后伸、外展和内收、内旋和外旋时以牛顿为单位的最大等长力量）以及融合位置。PROMs包括用于疼痛的视觉模拟量表（VAS；0 - 100，0表示无痛）和用于功能的手臂、肩部和手部残疾评分（DASH；0 - 100，0表示最佳评分）。
在最近一次随访时，患侧和非患侧的VAS疼痛评分中位数分别为49（0 - 96）和0。DASH评分为15（8 - 46），这意味着上肢功能为中等至良好。主动和被动后伸有显著差异（p = 0.028）。所有受试者表示在相同情况下他们会再次接受肩关节融合术。非患侧在各个方向上明显更强。融合术显示融合位置为外展31°（12 - 70）、前屈20°（10 - 50）和内旋22°（ - 14至58）。非患侧在每个运动方向上都明显更强（p≤0.05）。
在肩关节融合术后平均20年时，上臂丛神经损伤患者对功能改善良好至中等程度仍感到满意。
证据水平III：一项回顾性队列研究。
