Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO; Shriners Hospital for Children, St. Louis, MO.
Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO; Shriners Hospital for Children, St. Louis, MO.
J Hand Surg Am. 2020 Dec;45(12):1115-1122. doi: 10.1016/j.jhsa.2020.09.001. Epub 2020 Oct 23.
The purpose of this study was to examine radiographic and functional outcomes of the shoulder in brachial plexus birth injury (BPBI) patients at long-term follow-up.
Medical records were reviewed at the Shriners Hospital in St. Louis to identify patients older than 18 years with a diagnosis of BPBI. Twenty-five patients were included in this study. Evaluations included radiographic examination, clinical examination, and outcome measures including the Mallet classification, visual analog scale (VAS) for shoulder pain, American Shoulder and Elbow Shoulder score (ASES), quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Simple Shoulder Test (SST), and Patient-Reported Outcomes Measurement Information System (PROMIS) domain measures.
The mean age of the patients included was 44 years. Average follow-up was 37 years. No patient had primary nerve reconstruction surgery. Thirteen patients had a history of shoulder surgery at an average age of 6 years. There was a wide spectrum of deformity seen radiographically. Fifty-five percent of patients had evidence of glenoid retroversion, posterior humeral translation, or a biconcave glenoid. An additional 20% of patients had complete posterior dislocation of the humeral head. Despite the degenerative changes seen on radiographs, the mean VAS for pain was low, at 2. The mean ASES shoulder score was 54. The mean QuickDASH score was 30. Mean PROMIS Physical Function, Pain Interference, Depression, and Anxiety scores were near the means for the general population, with similar outcomes in patients treated with shoulder surgery compared with those treated without surgery.
Adult BPBI patients experience minimal shoulder pain despite deformity and degenerative changes on shoulder radiographs. Whereas there are significant deficits in range of motion and function, PROMIS scores in adult BPBI patients are normal.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在探讨臂丛神经损伤（BPBI）患者长期随访时的肩部影像学和功能结果。
在圣路易斯 Shriners 医院查阅病历，以确定诊断为 BPBI 且年龄大于 18 岁的患者。本研究共纳入 25 例患者。评估包括影像学检查、临床检查以及包括 Mallet 分级、肩部疼痛视觉模拟评分（VAS）、美国肩肘外科协会评分（ASES）、简易肩部测试（SST）、快速残疾评定量表（QuickDASH）和患者报告结局测量信息系统（PROMIS）域评分在内的结果测量指标。
患者的平均年龄为 44 岁，平均随访时间为 37 年，无患者接受过初次神经重建手术。13 例患者曾于 6 岁时行肩部手术，影像学上存在广泛的畸形。55%的患者存在肩胛盂后倾、肱骨头后移或双凹肩胛盂的证据，另有 20%的患者出现肱骨头完全后脱位。尽管影像学上存在退行性改变，但患者的肩部 VAS 疼痛评分较低，平均为 2 分，ASES 肩部评分平均为 54 分，QuickDASH 评分平均为 30 分。PROMIS 躯体功能、疼痛干扰、抑郁和焦虑评分的平均值接近一般人群，且接受肩部手术治疗与未接受手术治疗的患者的结果相似。
尽管存在肩部畸形和退行性改变，BPBI 成年患者的肩部疼痛仍较轻。虽然活动范围和功能存在显著缺陷，但 BPBI 成年患者的 PROMIS 评分正常。
研究类型/证据等级：治疗性 IV 级。
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