CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, 59000 Lille, France.
CHU Lille, Musculoskeletal Imaging Department, Hôpital Roger Salengro, 59000 Lille, France.
Orthop Traumatol Surg Res. 2022 Sep;108(5):103331. doi: 10.1016/j.otsr.2022.103331. Epub 2022 May 18.
Scapulothoracic arthrodesis may be proposed to patients having facio-scapulohumeral dystrophy to achieve gains in shoulder motion and pain relief. This study aimed to assess shoulder motion, pain and functional scores at last follow-up and to present a method of computed tomography measurements of the position of the scapulothoracic arthrodesis and study their correlations with shoulder motion.
Seven patients (11 arthrodesis) were included. Shoulder motion, pain, respiratory function and deltoid strength were compared with preoperative values and Constant, Brooke and Vignos scores were assessed at last follow-up. The elevation/depression and upward/downward position of the scapula were measured by performing postoperative 3D CT reconstruction. The protraction/retraction position was measured with 2D CT reconstructions on axial view. Correlations between these measurements and shoulder flexion and abduction were analysed. All complications were searched.
We found a significant improvement in mean VAS (from 3±2 to 1±1, p=0,008) shoulder flexion (64°± 11 to 113°±20, p=0,003) and abduction (from 63°±9 to 92°±13°, p=0,004). Postoperative external rotation wasn't significantly different (from 49°±19 to 43°±10, p=0,112) and on internal rotation, the hand reached on average the 9th thoracic vertebra (S1-T2). Scapulothoracic arthrodesis was mainly positioned in regard to the 1 and the 6 rib. The mean protraction/retraction position was 38,5°±8° and the mean scapular upward/downward rotation position was 92°±15°. No correlations were found between the scapular position and shoulder flexion and abduction.
Scapulothoracic arthrodesis for facioscapulohumeral dystrophy improved pain, shoulder flexion and abduction and provided good functional outcomes at 3,5 to 13 years of follow up. A method of CT assessment of the position of the arthrodesis is presented to analyse precisely the position of the scapula but no correlations with shoulder motions were found. Preoperative evaluation of deltoid function and scapular winging seemed to be the most important predictors of shoulder motions gains after this procedure.
III, Retrospective cohort study.
对于患有面肩肱型肌营养不良症的患者，可考虑行肩胛胸壁融合术以获得肩关节活动度的改善和疼痛缓解。本研究旨在评估末次随访时的肩关节活动度、疼痛和功能评分，并介绍一种肩胛胸壁融合术后 CT 测量位置的方法，并研究其与肩关节活动度的相关性。
共纳入 7 名患者（11 例融合术）。比较术前和末次随访时的肩关节活动度、疼痛、呼吸功能和三角肌力量，评估Constant、Brooke 和 Vignos 评分。通过术后 3D CT 重建测量肩胛骨的抬高/降低和上/下位置，通过轴位 2D CT 重建测量肩胛骨的前/后位置。分析这些测量值与肩关节前屈和外展的相关性。所有并发症均被搜索。
我们发现 VAS 评分（从 3±2 降至 1±1，p=0.008）、肩关节前屈（从 64°±11 增至 113°±20，p=0.003）和外展（从 63°±9 增至 92°±13，p=0.004）均有显著改善。术后外旋无明显差异（从 49°±19 降至 43°±10，p=0.112），内旋时手平均可达第 9 胸椎（S1-T2）。肩胛胸壁融合术主要位于第 1 肋和第 6 肋。肩胛骨的前/后位置平均为 38.5°±8°，肩胛骨上/下旋转位置平均为 92°±15°。肩胛骨位置与肩关节前屈和外展无相关性。
对于面肩肱型肌营养不良症患者，肩胛胸壁融合术可改善疼痛、肩关节前屈和外展，并在 3.5 至 13 年的随访中获得良好的功能结果。本研究提出了一种 CT 评估融合术位置的方法，可以精确分析肩胛骨的位置，但与肩关节运动无相关性。术前三角肌功能和肩胛骨翼状肩的评估似乎是该手术肩关节运动改善的最重要预测因素。
III 级，回顾性队列研究。
