Abzug Joshua M, Wyrick-Glover Theresa O, Case Alexandria L, Zlotolow Dan A, Kozin Scott H
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
University of Arkansas for Medical Sciences, Little Rock, AK.
J Pediatr Orthop. 2019 Mar;39(3):e232-e235. doi: 10.1097/BPO.0000000000001251.
Loss of midline function impairs the child's ability to perform certain activities of daily living such as dressing, buttoning, and perineal care. The purpose of this study was to assess brachial plexus birth palsy (BPBP) patients with loss of midline function with respect to etiology and treatment.
A retrospective review of all BPBP patients with loss of midline function was performed. The modified Mallet scale was used with internal rotation assessed via hand on spine and hand to belly. Demographics, extent of BPBP, prior surgical intervention, procedure(s) performed to correct the loss of midline function, complications, and outcomes were assessed.
In total, 20 patients were identified with loss of midline function as defined by the inability to reach midline and touch their umbilicus. Nineteen patients had previously undergone tendon transfers about the shoulder with or without arthroscopic capsular release to improve external rotation. After the initial surgery, modified Mallet scores improved 1 grade for abduction, hand to mouth, hand to neck, and external rotation without altering the hand to spine category. However, the internal rotation category (hand to umbilicus) decreased from an average 2.71 preoperatively to an average 2.15 postoperatively. Nine patients underwent a derotational humeral osteotomy to improve midline function. The average correction of internal rotation was 47.8 degrees (range, 20 to 85 degrees). After this surgery, modified Mallet scores remained unchanged for hand to spine; however, the scores improved back to 2.7 for the internal rotation category. Two complications were noted including 1 plate fracture and 1 fracture through a screw hole.
BPBP patients who undergo surgical procedures to improve shoulder external rotation and/or obtain joint reduction may inadvertently lose midline function. Derotational humeral osteotomy can effectively restore midline function, which is needed to perform activities of daily living. Surgical procedures to improve external rotation should be performed in a manner that minimizes limitation of midline functions.
Level III-therapeutic.
中线功能丧失会损害儿童进行某些日常生活活动的能力，如穿衣、扣纽扣和会阴护理。本研究的目的是评估中线功能丧失的臂丛神经产瘫（BPBP）患者的病因和治疗情况。
对所有中线功能丧失的BPBP患者进行回顾性研究。采用改良马利特量表，通过手触脊柱和手触腹部来评估内旋情况。评估患者的人口统计学资料、BPBP的程度、先前的手术干预、为纠正中线功能丧失而进行的手术操作、并发症及结果。
共有20例患者被确定存在中线功能丧失，定义为无法触及中线和肚脐。19例患者先前已接受肩部肌腱转移术，伴或不伴关节镜下关节囊松解术以改善外旋功能。初次手术后，改良马利特评分在外展、手到口、手到颈和外旋方面提高了1级，而手触脊柱类别未改变。然而，内旋类别（手到肚脐）从术前平均2.71降至术后平均2.15。9例患者接受了肱骨旋转截骨术以改善中线功能。内旋平均矫正角度为47.8度（范围为20至85度）。该手术后，改良马利特评分在“手触脊柱”方面保持不变；然而，内旋类别的评分恢复到了2.7。记录到2例并发症，包括1例钢板骨折和1例螺钉孔处骨折。
接受手术以改善肩部外旋和/或实现关节复位的BPBP患者可能会无意中丧失中线功能。肱骨旋转截骨术可有效恢复中线功能，而中线功能是进行日常生活活动所必需的。改善外旋的手术操作应以尽量减少对中线功能限制的方式进行。
三级治疗性。
