Department of Hand Surgery, Karolinska Institutet Department of Clinical Science and Education, Södersjukhuset, Sweden.
J Hand Surg Eur Vol. 2022 Mar;47(3):237-242. doi: 10.1177/17531934211034968. Epub 2021 Aug 3.
Internal rotation contracture of the shoulder is a common sequel of the brachial plexus birth palsy. The purpose of this study is to describe the surgical method used in our centre and to measure the effect of sequentially releasing several anatomical structures that have been ascribed as the cause of the contracture. Twenty-four consecutive patients were operated on with an open release. We documented the increase in passive external rotation after each surgical step. We found small gains in passive external rotation when performing coracoidectomy and division of the upper part of the subscapularis tendon; 4° (95% confidence interval [CI] 2°-6° < 0.01) and 6° (95% CI 4°-8° < 0.01), respectively. A substantial gain in external rotation occurred when dividing the entire subscapularis tendon, 43° (95% CI 38°-48°, < 0.01). Our findings indicate that a clinically relevant surgical release of the contracture requires lengthening of the entire subscapularis musculo-tendinous unit. IV.
肩内旋挛缩是臂丛神经产伤的常见后遗症。本研究旨在描述我们中心使用的手术方法，并测量依次释放被认为是挛缩原因的几种解剖结构的效果。24 例连续患者接受了开放性松解术。我们记录了每一步手术治疗后被动外旋的增加量。我们发现，行喙突切除术和肩胛下肌上部肌腱切断术时，被动外旋的增加量较小，分别为 4°（95%置信区间 [CI] 2°-6° < 0.01）和 6°（95% CI 4°-8° < 0.01）。当完全切断肩胛下肌肌腱时，外旋可获得较大增加，达到 43°（95% CI 38°-48° < 0.01）。我们的研究结果表明，要实现挛缩的临床相关手术松解，需要延长整个肩胛下肌肌肌腱单位。IV.
