McKellar Sean R, Kay Jeffrey, Memon Muzammil, Simunovic Nicole, Kishta Waleed, Ayeni Olufemi R
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Curr Rev Musculoskelet Med. 2022 Apr;15(2):107-120. doi: 10.1007/s12178-022-09747-6. Epub 2022 Feb 14.
Consensus on the effects of soft tissue surgical intervention in the management of brachial plexus birth injury (BPBI) sequalae is lacking. The purpose of this review is to examine the available literature on the functional and structural outcomes following soft tissue surgical management of BPBI sequalae.
EMBASE, PubMed, and MEDLINE were searched for related literature from the point of database inception until April 2021. Relevant papers were screened by two reviewers independently and in duplicate. A meta-analysis was performed using a random effects model. A total of 25 studies (852 patients) were included in the review, with the number included in each meta-analysis varying based on outcome of interest. There were significant improvements from pre- to post-operative time points for the following measures: Mallet aggregate scores (5.0 points, p<0.0001), active external rotation in adduction (48.9°, p=0.003), passive external rotation in adduction (64.6°, p< 0.00001), active abduction (46.2°, p<0.00001), glenoid version (14.4°, p< 0.00001), and percentage of the humeral head anterior to the scapular line (17.53°, p< 0.00001). Furthermore, data revealed an overall complication rate of 9.3% (79/852 patients) and a major complication rate of 0.47% (4/852 patients). Patients with BPBI sequela experience statistically significant improvements in functional, structural, and range of motion outcomes of the GH joint following soft tissue surgical management. Understanding the ideal indications for each procedure and age of surgical management with future prospective studies will help to optimize surgical management of these patients.
对于软组织手术干预在臂丛神经产伤（BPBI）后遗症管理中的效果，目前尚未达成共识。本综述的目的是研究关于BPBI后遗症软组织手术管理后功能和结构结果的现有文献。
在EMBASE、PubMed和MEDLINE数据库中检索了从建库至2021年4月的相关文献。由两名审稿人独立且重复地筛选相关论文。采用随机效应模型进行荟萃分析。本综述共纳入25项研究（852例患者），每项荟萃分析纳入的数量根据感兴趣的结果而有所不同。以下指标从术前到术后时间点有显著改善：槌状指综合评分（5.0分，p<0.0001）、内收位主动外旋（48.9°，p=0.003）、内收位被动外旋（64.6°，p<0.00001）、主动外展（46.2°，p<0.00001）、关节盂倾斜度（14.4°，p<0.00001）以及肱骨头位于肩胛线前方的百分比（17.53°，p<0.00001）。此外，数据显示总体并发症发生率为9.3%（79/852例患者），主要并发症发生率为0.47%（4/852例患者）。BPBI后遗症患者在软组织手术管理后，其肩关节的功能、结构和活动范围结果有统计学意义的改善。通过未来的前瞻性研究了解每种手术的理想适应证和手术管理年龄，将有助于优化这些患者的手术管理。
