Nath Rahul K, Somasundaram Chandra
Texas Nerve and Paralysis Institute, Houston, Texas.
Eplasty. 2022 Feb 8;22:e2. eCollection 2022.
External Rotational Humeral osteotomy is used to address the external rotation deficit in older children with obstetric brachial plexus Injury (OBPI). Although this procedure improves the cosmetic effect of shoulder subluxation, it has no effect on the underlying structural (glenohumeral deformity and scapular elevation and rotation) and functional problems. In this study, improvements in glenohumeral joint alignment; scapular hypoplasia, elevation, and rotation (SHEAR) deformity; and upper extremity functional movements were demonstrated in adult patients with OBPI 1 year after the mod Quad and/or triangle tilt surgeries.
The outcome of humeral rotational osteotomy reported in the literature was compared with the results from 43 adult patients with OBPI (21 men and 22 women; 23 right and 20 left sides) with a mean age of 21.3 years (range, 17 to 38 years) who underwent mod Quad and/or triangle tilt surgeries and had over 12 months of postoperative follow-up (mean 22.9 months; range, 12 to 50 months).
The preoperative average modified total Mallet score, including supination, was 14.6 ± 3.5 ( < 0.0001) in the 43 adult patients with OBPI in this report. This total Mallet score was significantly improved to 22 ± 3.9 ( < 0.0001) over 12 months after mod Quad and/or triangle tilt surgeries. Thirty-two (75%) of the patients showed great improvement in all upper extremity functions: shoulder abduction, external rotation, hand-to-mouth, hand-to-neck, hand-to-spine, and supination. The improvement after humeral osteotomy reported in the literature was a cosmetic effect that did not address the underlying structural and functional problems and was found to decrease the improved shoulder abduction in long-term follow-up.
Thirty-two (75%) of 43 adult patients with OBPI showed great improvement in all upper extremity functions 1 year after mod Quad and/or triangle tilt surgeries. The other 11 patients (25%) showed improvement in hand-to-mouth movement and/or supination. In contrast, humeral osteotomy, as reported in the literature, improved the cosmetic effect of shoulder subluxation but had no effect on the underlying structural and functional problems.
肱骨外旋截骨术用于解决大龄产瘫（OBPI）儿童的外旋功能障碍。尽管该手术改善了肩关节半脱位的外观，但对潜在的结构问题（盂肱关节畸形、肩胛骨抬高和旋转）和功能问题并无作用。在本研究中，接受改良四边形和/或三角形倾斜手术的成年产瘫患者在术后1年，其盂肱关节对线、肩胛骨发育不全、抬高和旋转（SHEAR）畸形以及上肢功能运动均有改善。
将文献报道的肱骨旋转截骨术的结果与43例成年产瘫患者（21例男性和22例女性；23例右侧和20例左侧）的结果进行比较，这些患者平均年龄为21.3岁（范围17至38岁），接受了改良四边形和/或三角形倾斜手术，且术后随访超过12个月（平均22.9个月；范围12至50个月）。
本报告中43例成年产瘫患者术前包括旋后功能在内的平均改良总马利特评分是14.6±3.5（<0.0001）。在改良四边形和/或三角形倾斜手术后12个月内，该总马利特评分显著提高至22±3.9（<0.0001）。32例（75%）患者的所有上肢功能（肩关节外展、外旋、手至口、手至颈、手至脊柱和旋后）均有显著改善。文献报道的肱骨截骨术后的改善只是外观上的，并未解决潜在的结构和功能问题，且在长期随访中发现会降低改善后的肩关节外展功能。
43例成年产瘫患者中有32例（75%）在改良四边形和/或三角形倾斜手术后1年，所有上肢功能均有显著改善。另外11例患者（25%）在手至口运动和/或旋后功能方面有改善。相比之下，文献报道的肱骨截骨术改善了肩关节半脱位的外观，但对潜在的结构和功能问题并无作用。
