Department of Orthopaedic Surgery, University of Pittsburgh Medical Center-Hamot, Erie.
Kinesiology Program, School of Behavioral Sciences and Education, Pennsylvania State University Harrisburg, Middletown.
J Hand Surg Am. 2021 Jul;46(7):624.e1-624.e11. doi: 10.1016/j.jhsa.2020.11.021. Epub 2021 Jan 30.
Glenohumeral (GH) joint reductions are frequently performed during tendon transfer surgery for brachial plexus birth injuries (BPBI); however, the effect of reduction method (none required, closed, surgical) has not been assessed. This study compared objective, functional, and patient-reported outcomes between children who underwent a tendon transfer and (1) did not require GH reduction, (2) required concomitant closed GH reduction, or (3) required concomitant surgical GH reduction.
Fifty-four children with BPBI who previously underwent teres major and/or latissimus dorsi transfer with or without concomitant GH reduction participated. Joint reduction method was classified as none required (n = 21), closed (n = 9), or surgical (n = 24). Motion capture was collected in a neutral position, abduction, external rotation, and internal rotation. Glenohumeral joint angles and displacements were calculated. Joint angular displacements represented the differences between the joint angles in each terminal position and the joint angles of the arm at rest in the neutral position. A hand surgeon determined modified Mallet scores. Participants' parents completed the Brachial Plexus Profile Activity Short Form (BP-PRO-SF) to assess physical activity performance.
The no-reduction group had significantly less GH elevation than the surgical-reduction group for all positions and significantly less GH elevation than the closed-reduction group for the neutral, external rotation, and internal rotation positions. There were no differences in GH rotation angles. Glenohumeral joint displacements from neutral and modified Mallet scores were similar. The no-reduction group demonstrated significantly greater BP-PRO-SF scores than the surgical-reduction group.
Patients who underwent a closed or surgical GH joint reduction consistently displayed more GH elevation. Clinically, this corresponds to an abduction contracture. Whereas increased abduction contracture provided a benefit of greater overhead motion, modified Mallet scores were similar between groups. The surgical-reduction group demonstrated lower BP-PRO-SF outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
在治疗臂丛神经出生损伤（BPBI）的肌腱转移手术中，经常需要进行盂肱（GH）关节复位；然而，尚未评估复位方法（无需、闭合、手术）的效果。本研究比较了接受肌腱转移手术的儿童中，（1）无需 GH 复位、（2）需要同时行闭合 GH 复位、或（3）需要同时行手术 GH 复位的患者之间的客观、功能和患者报告结果。
54 名曾接受过背阔肌和/或大圆肌转移术且伴有或不伴有 GH 复位的 BPBI 患儿参与了本研究。关节复位方法分为无需复位（n=21）、闭合复位（n=9）或手术复位（n=24）。在中立位、外展位、外旋位和内旋位采集运动捕捉数据。计算盂肱关节角度和位移。关节角位移代表每个终末位置的关节角与中立位时手臂休息时的关节角之间的差异。手外科医生确定改良的 Mallet 评分。参与者的父母使用臂丛神经丛损伤概况活动简表（BP-PRO-SF）评估其身体活动表现。
与手术复位组相比，无需复位组在所有位置的 GH 抬高角度均显著更小，与闭合复位组相比，在中立位、外旋位和内旋位的 GH 抬高角度均显著更小。GH 旋转角度无差异。从中立位和改良 Mallet 评分来看，盂肱关节位移相似。无需复位组的 BP-PRO-SF 评分显著高于手术复位组。
行闭合或手术 GH 关节复位的患者始终表现出更大的 GH 抬高。从临床角度来看，这对应着外展挛缩。虽然增加的外展挛缩提供了更大的过顶运动益处，但组间改良 Mallet 评分相似。手术复位组的 BP-PRO-SF 结果较低。
研究类型/证据水平：治疗性 IV 级。
