Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, Netherlands.
Department of Orthopedic Surgery, Balgrist University Hospital, Zürich, Switzerland.
Bone Joint J. 2023 Mar 15;105-B(4):455-464. doi: 10.1302/0301-620X.105B4.BJJ-2022-1069.R1.
Multiple secondary surgical procedures of the shoulder, such as soft-tissue releases, tendon transfers, and osteotomies, are described in brachial plexus birth palsy (BPBP) patients. The long-term functional outcomes of these procedures described in the literature are inconclusive. We aimed to analyze the literature looking for a consensus on treatment options. A systematic literature search in healthcare databases (PubMed, Embase, the Cochrane library, CINAHL, and Web of Science) was performed from January 2000 to July 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The quality of the included studies was assessed with the Cochrane ROBINS-I risk of bias tool. Relevant trials studying BPBP with at least five years of follow-up and describing functional outcome were included. Of 5,941 studies, 19 were included after full-text screening. A total of 15 surgical techniques were described. All studies described an improvement in active external rotation (range 12° to 128°). A decrease in range of motion and Mallet score after long-term (five to 30 years) follow-up compared to short-term follow-up was seen in most studies. The literature reveals that functional outcome increases after different secondary procedures, even in the long term. Due to the poor methodological quality of the included studies and the variations in indication for surgery and surgical techniques described, a consensus on the long-term functional outcome after secondary surgical procedures in BPBP patients cannot be made.
在臂丛神经损伤性产瘫（BPBP）患者中，常需要进行多次肩部外科手术，如软组织松解、肌腱转移和截骨术等。这些手术的长期功能效果在文献中尚无定论。我们旨在分析文献，寻找关于治疗方案的共识。根据系统评价和荟萃分析的首选报告项目，从 2000 年 1 月至 2020 年 7 月，我们在医疗保健数据库（PubMed、Embase、Cochrane 图书馆、CINAHL 和 Web of Science）中进行了系统文献检索。使用 Cochrane ROBINS-I 偏倚风险工具评估纳入研究的质量。纳入了至少随访五年并描述功能结果的研究 BPBP 的相关试验。在全文筛选后，共有 19 项研究被纳入。共描述了 15 种手术技术。所有研究均描述了主动外旋的改善（范围 12°至 128°）。大多数研究发现，在长期（5 至 30 年）随访中，与短期随访相比，活动范围和 Mallet 评分降低。文献表明，在不同的二次手术后，即使是长期，功能结果也会提高。由于纳入研究的方法学质量较差，以及手术指征和所描述的手术技术存在差异，因此无法就 BPBP 患者二次手术后的长期功能结果达成共识。
