Rainbow Superspeciality Hospital & Children's Orthopaedic Centre, Next to Asia School, Behind HDFC bank, Opposite Drive In Cinema, Bodakdev, Ahmedabad, Gujarat, 380 054, India.
Smt. S C L Hospital, NHM Municipal Medical College, Ahmedabad, Gujarat, India.
Int Orthop. 2020 Dec;44(12):2653-2663. doi: 10.1007/s00264-020-04850-0. Epub 2020 Oct 23.
Sprengel's deformity though rare is the most common congenital anomaly of the shoulder region. The aim of the study was to check the effectiveness of the modified Green's procedure with simplified clavicle osteotomy in providing significant functional and radiological improvement without neurovascular complications.
Sixty-eight children of Sprengel deformity were operated by the modified Green's release. Of which forty patients (15 male, 25 female) with more than two years follow-up were evaluated retrospectively. Simplified clavicle osteotomy was done in 34 patients. Severity was graded clinically by Cavendish grading (Grade II-6, III-34) and radiologically by Rigault grading (Grade II - 35, III - 5). The average age at surgery was 5.05 years with a mean follow-up of 62 (24-145) months.
The average improvement in Cavendish grade was 2.6 grades, and Rigault grading was 1.07 grades. Shoulder abduction improved by a mean of 36. There was no neurovascular complication in children who had simplified clavicle osteotomy, and one patient without clavicle osteotomy developed transient brachial plexus palsy. Other complications were wound gape, pleural tear and scapular winging.
The modified Green's procedure with simplified clavicle osteotomy allows for excellent correction of function and cosmesis. We describe a simpler technique of clavicle osteotomy that is quick, safe and equally effective in preventing neurovascular complications. We also describe a surrogate clinical test to avoid potential neurological injury in the absence of neuromonitoring. To the best of our knowledge, this is the second-largest operative series of Sprengel's deformity.
尽管 Sprengel 畸形较为罕见，但它是肩部最常见的先天性畸形。本研究旨在检查改良 Green 手术联合简化锁骨截骨术的有效性，该手术在不引起神经血管并发症的情况下，显著改善功能和影像学结果。
对 68 例 Sprengel 畸形患儿采用改良 Green 松解术进行治疗。其中 40 例（15 例男性，25 例女性）患者的随访时间超过 2 年，采用回顾性研究方法进行评估。其中 34 例行简化锁骨截骨术。临床采用 Cavendish 分级（II 级-6 例，III 级-34 例）和 Rigault 分级（II 级-35 例，III 级-5 例）评估严重程度。手术平均年龄为 5.05 岁，平均随访时间为 62 个月（24-145 个月）。
Cavendish 分级的平均改善程度为 2.6 级，Rigault 分级的平均改善程度为 1.07 级。肩外展平均改善 36°。行简化锁骨截骨术的患儿无神经血管并发症，未行锁骨截骨术的 1 例患儿出现短暂性臂丛神经麻痹。其他并发症包括切口裂开、气胸和肩胛骨翼状畸形。
改良 Green 手术联合简化锁骨截骨术可显著改善功能和美容效果。我们描述了一种更简单的锁骨截骨技术，该技术快速、安全，同样能有效预防神经血管并发症。我们还描述了一种替代的临床测试方法，以避免在没有神经监测的情况下潜在的神经损伤。据我们所知，这是第二大规模的 Sprengel 畸形手术系列。
