Pignet Anna-Lisa, Kranzl Andreas, Hecker Andrzej, Weigel Gerlinde, Kamolz Lars-Peter, Girsch Werner
Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria.
Laboratory for Gait and Movement Analysis, Orthopaedic Hospital Vienna-Speising, 1130 Vienna, Austria.
J Clin Med. 2024 May 8;13(10):2759. doi: 10.3390/jcm13102759.
Internal rotation contractures of the shoulder are common sequelae of conservatively treated obstetric brachial plexus palsy (OBPP) with incomplete spontaneous neurological recovery. Humerus derotation osteotomy has been suggested as a possible treatment option to improve arm positioning. However, consensus as to whether humerus derotation osteotomy can successfully restore limb function is missing. In the present controlled cohort study, we aimed at analyzing global upper extremity kinematics with a 3D-video analysis system in children with shoulder internal rotation contractures secondary to OBPP before, and one year after, humerus derotation osteotomy. Patients under 18 years of age that presented to our center with conservatively treated internal rotation contractures of the shoulder and subsequently underwent humerus derotation osteotomy were included. The unimpaired arm served as a respective control. Pre-operatively, all patients showed severe internal rotation contractures of the shoulder of almost 60° at rest. At the follow-up, the position of the shoulder at rest was greatly shifted to 9° of internal rotation. The patients showed statistically significant improvement in maximum external rotation and abduction of the shoulder, as well as in maximum flexion of the elbow, and the range of motion of pro/supination. The maximum internal rotation of the shoulder, however, was diminished after the osteotomy. Our data indicated that derotational osteotomy is a promising procedure which can be used to correct for internal rotation contractures secondary to OBPP. Moreover, 3D-video analysis proved to be a useful tool that supplies the surgeon with both precise information about the degree of distortion pre-operatively, thus helping to decide on the amount of correction, and secondly, a measurement of the post-operative gain in upper extremity function.
肩部内旋挛缩是保守治疗的产瘫（OBPP）且神经功能未完全自发恢复后的常见后遗症。肱骨旋转截骨术被认为是改善手臂姿势的一种可能治疗选择。然而，对于肱骨旋转截骨术能否成功恢复肢体功能尚无共识。在本对照队列研究中，我们旨在使用三维视频分析系统分析产瘫继发肩部内旋挛缩患儿在肱骨旋转截骨术前及术后一年的全上肢运动学情况。纳入了18岁以下因肩部内旋挛缩接受保守治疗并随后接受肱骨旋转截骨术的患者，以健侧手臂作为相应对照。术前，所有患者在静息时均表现出近60°的严重肩部内旋挛缩。随访时，静息时肩部位置大幅转变为内旋9°。患者在肩部最大外旋和外展、肘部最大屈曲以及旋前/旋后的活动范围方面有统计学意义的改善。然而，截骨术后肩部最大内旋减小。我们的数据表明，旋转截骨术是一种有前景的手术方法，可用于纠正产瘫继发的内旋挛缩。此外，三维视频分析被证明是一种有用的工具，它既能为外科医生提供术前畸形程度的精确信息，从而有助于确定矫正量，又能测量术后上肢功能的改善情况。
