Brogan David M, Leversedge Fraser J
1 Washington University in St. Louis, MO, USA.
2 Duke University, Durham, NC, USA.
Hand (N Y). 2019 Jan;14(1):34-41. doi: 10.1177/1558944718803746. Epub 2018 Oct 7.
Birth brachial plexus injury usually affects the upper trunks of the brachial plexus and can cause substantial loss of active shoulder external rotation and abduction. Due to the unbalanced rotational forces acting at the glenohumeral joint, the natural history of the condition involves progressive glenohumeral joint dysplasia with associated upper limb dysfunction. Surgical reconstruction methods have been described previously by Sever and L'Episcopo, and modified by Hoffer and Roper to release the adduction contracture and to restore external rotation and shoulder abduction.
The authors describe their preferred technique for contracture release and tendon transfer to improve external rotation and shoulder abduction. Pertinent anatomy and highlights of surgical exposure are reviewed.
The senior author has utilized this technique with consistent clinical outcomes to improve shoulder function for patients with persisting nerve palsy associated with birth brachial plexus injury. A review of the literature supports utilization of this technique.
Transfer of the latissimus dorsi and teres major to the posterior rotator cuff for reanimation of shoulder abduction and external rotation deficits associated with birth brachial plexus injury is a safe and reliable technique. Careful patient selection and attention to surgical detail are critical for optimal outcomes.
产伤性臂丛神经损伤通常累及臂丛神经的上干，可导致主动肩外旋和外展功能严重丧失。由于作用于盂肱关节的旋转力不平衡，该病的自然病程包括进行性盂肱关节发育不良及相关的上肢功能障碍。Sever和L'Episcopo此前已描述过手术重建方法，Hoffer和Roper对其进行了改良，以松解内收挛缩并恢复外旋和肩外展功能。
作者描述了他们首选的挛缩松解和肌腱转移技术，以改善外旋和肩外展功能。回顾了相关解剖结构及手术显露要点。
资深作者运用该技术取得了一致的临床效果，改善了产伤性臂丛神经损伤所致持续性神经麻痹患者的肩部功能。文献回顾支持该技术的应用。
将背阔肌和大圆肌转移至肩袖后部，以恢复产伤性臂丛神经损伤相关的肩外展和外旋功能障碍，是一种安全可靠的技术。仔细的患者选择和对手术细节的关注对获得最佳疗效至关重要。
