Department of Orthopaedics, University Institute for Locomotion and Sports, Pasteur 2 Hospital, Nice, France.
Groupe Chirurgicale Tiers, Grenoble, France.
J Shoulder Elbow Surg. 2020 May;29(5):931-940. doi: 10.1016/j.jse.2019.10.006. Epub 2020 Jan 22.
Scapulothoracic arthrodesis (STA) has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy (FSHD). However, the rate of osseous fusion is variable, and there is a theoretical risk of reduced respiratory function after bilateral STA.
This was a retrospective study of 10 STAs, performed sequentially, in 5 FSHD patients. The surgical technique involved use of a semitubular plate and wire construct with autograft (iliac crest) interposed between the scapula and rib cage. Osseous fusion, respiratory function, and shoulder function were evaluated. The mean follow-up period was 141 ± 67 months (range, 24-225 months).
Early complications included 1 pneumothorax and 1 pleural effusion. No late complications occurred, and no patients underwent reoperation. On postoperative computed tomography images, complete bony union of the scapula to the ribs was observed in 90% of shoulders (9 of 10). Comparison of preoperative and postoperative pulmonary function test results showed no significant difference in vital capacity (from 87% ± 14% to 85% ± 12%) and forced vital capacity (from 86% ± 16% to 77% ± 15%). Patients gained on average 40° of active forward elevation (from 62° ± 20° to 102° ± 4°) and 22° of abduction (from 58° ± 21° to 89° ± 7°) (P < .001). The mean Subjective Shoulder Value increased from 25% ± 8% to 72% ± 18% (P < .001). All patients were pleased with the results and would recommend the procedure to other persons.
In patients with FSHD, bilateral STA provides satisfactory shoulder function with a high rate of scapulothoracic fusion and few or no significant respiratory repercussions.
肩胛骨胸壁融合术（STA）已被提议用于治疗面肩肱型肌营养不良症（FSHD）患者的肩胛骨翼状畸形。然而，骨融合率是可变的，双侧 STA 后存在呼吸功能降低的理论风险。
这是一项回顾性研究，共纳入 5 例 FSHD 患者的 10 例 STA。手术技术包括使用半管状板和线构建物，自体髂嵴骨移植物置于肩胛骨和胸廓之间。评估骨融合、呼吸功能和肩部功能。平均随访时间为 141 ± 67 个月（范围，24-225 个月）。
早期并发症包括 1 例气胸和 1 例胸腔积液。无晚期并发症，无患者再次手术。术后 CT 图像显示，90%（9/10）的肩部观察到肩胛骨与肋骨完全骨性融合。术前和术后肺功能测试结果比较显示，肺活量（从 87%±14%降至 85%±12%）和用力肺活量（从 86%±16%降至 77%±15%）无显著差异。患者平均获得 40°主动前屈（从 62°±20°增至 102°±4°）和 22°外展（从 58°±21°增至 89°±7°）（P<0.001）。主观肩部值平均从 25%±8%增加到 72%±18%（P<0.001）。所有患者对结果均满意，并愿意向他人推荐该手术。
在 FSHD 患者中，双侧 STA 提供满意的肩部功能，肩胛骨胸壁融合率高，且对呼吸功能的影响较小或无显著影响。
